Gender Evaluation of the Ebola Response at Moyamba ETC | Ebola Virus Disease | Violence

© W W W. J O R G E S A E TA F O T O .

C O M

Gender Evaluation
of the Doctors of the World and Médicos del Mundo
Ebola response in Moyamba Ebola Treatment Center Project
Moyamba District, Sierra Leone march 2016

Author: Helea Sáiz Bermejo (MdM)

Title of the assessment
Gender Evaluation of the Dotw/MdM Ebola response
in Moyamba ETC Project
Title of the assessment
Moyamba District, Sierra Leone
Author
Helea Sáiz Bermejo
Reviewed by
Yedra García Bastante, Leticia Silvela Coloma, Nicolás Dotta
Administration and cultural adaptation
of questionnaires done by
Abdul Rahman Conteh
Graphic Design
Cósmica®
Involved partners
DHMT, DERC, Ministry of Social Welfare, Gender and Children’s
Affairs, WHO, Solidaritès International, AcF, Oxfam, MsF, IRC,
Women’s Forum, Forum for African Women Educationalist (FAWE),
Gender and Empowerment, Peagie Woobay Scholarship Fund
Funded by DFID-UK AID

This report is intended for broad dissemination within
the humanitarian community and its different forums
of coordination and information. It is not subject to any
restrictions but should be properly cited if referred to.

Gender Evaluation
of the Doctors of the World and Médicos del Mundo
Ebola response in Moyamba Ebola Treatment Center Project
Moyamba District, Sierra Leone march 2016

Author: Helea Sáiz Bermejo (MdM)

Acknowledgments
To Mama Salone and its powerful women, for teaching me, once
again, the meaning of the word SISTERHOOD.

4 I Moyamba District, Sierra Leone. March 2016

Table of Contents
Acknowledgments

4

Table of Contents

5

List of Tables

6

List of Graphics

7

List of Acronyms

8

Purpose and Objectives of the Study

9

EXECUTIVE SUMMARY

10

Timeframe and Location

12

Methodology

13

GENDER CONTEXT

15

FINDINGS

23

Infrastructure

23

AWARENESS RAISING, CASE DETECTION AND
TRANSFER TO THE ETC

25

TRIAGE & TREATMENT

28

DISCHARGE

29

Staff

30

EDUCATION

30

ORIGIN

31

POSITIONS AND ROLES OF WOMEN AND MEN

32

LEADERSHIP

34

USE OF TIME

35

USE AND CONTROL OF RESOURCES

37

IMPACT OF WORKING IN AN ETC

40

CONCLUSIONS

42

RECOMMENDATIONS

44

References

46

Annexes

47

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 5

List of Tables
Table 1

Number and percentages of male and female
staff interviewed

13

Number of staff interviewed: position, sex and
percentage

13

Cumulative number of confirmed cases by sex
and age group in Sierra Leone

15

Table 4

Total population of Moyamba District by sex

16

Table 5

Teenage pregnancies in Moyamba Chiefdoms

21

Table 6

Confirmed, probable and suspected Ebola
cases in Sierra Leone

42

Table 2
Table 3

6 I Moyamba District, Sierra Leone. March 2016

List of Graphics
Figure 1

Ward in Kissy maternity (MsF)

18

Figure 27 Have you changed the location to work in the
ETC? (Men)

Figure 2

Ward in Magburaka (MsF)

18

33

Figure 3

Ward in Goderich (Emergency)

19

Figure 28 Are you the head of the household?

33

Figure 4

Ward in Kerry Town (Save the Children)

19

Figure 29 Household heads disaggregated by sex and
age

34

Figure 5

Dead body management inside the ward in
Kenema (RC)

19

Figure 30 Household heads in the homes of the
respondents

34

Increase of teenage pregnancies in Moyamba
District

21

Figure 31 leadership positions held by women and men
in the ETC

34

Aerial photo of Ebola Treatment Centre,
Moyamba

22

Figure 32 What would you like to do after the closing of
the ETC?

35

Figure 8

Moyamba ETC map

23

Figure 9

Does the ETC respect local customs?

24

Figure 33 Are your daily activities the same as before
you started working at the ETC?

36

Figure 34 Percentage of women and men taking care of
house cores BEFORE working in the ETC

36

Figure 35 Percentage of women and men taking care of
house cores AFTER working in the ETC

36

Figure 36 Who decides what to do and how to use the
incomes at home?

37

Figure 37 Decision making, regarding the incomes, at
home level disaggregated by sex and age
(Women)

37

37

Figure 6
Figure 7

Figure 10 Challenges for male and female patients
inside the ETC

24

Figure 11 D 
o you think there were cases of sexual
harassment/violence/abuse inside the ETC?

24

Figure 12 ETC admissions per chiefdom

26

Figure 13 PCR results per chiefdom

26

Figure 14 Female Ebola Cases in Moyamba District

27

Figure 15 Male Ebola Cases in Moyamba District

27

Figure 16 ETC admissions by age and gender

27

Figure 38 Decision making, regarding the incomes, at
home level disaggregated by sex and age
(Men)

Figure 17 PCR results by gender

28

Figure 39 Use of incomes

38

Figure 18 Age and studies of the staff interviewed

30

Figure 40 Is your partner working (Women)

38

Figure 19 Districts staff is coming from

31

Figure 41 Is your partner working (Men)

38

Figure 20 Chiefdoms in Moyamba staff is coming from

31

Figure 42 Improvements for men and women due to
their job at the ETC

39

Figure 43 Challenges for men and women due to their
job at the ETC

39

Figure 44 Have you been subjected to stigma or
rejection because of your work in an ETC?

40

Figure 45 Have you felt any kind of discrimination (race,
sex, position, religion, status...) in the ETC?

40

Figure 46 Did you suffer any sexual harassment/
violence/abuse in the ETC?

40

Figure 21 Town/Villages in Moyamba staff is coming
from

31

Figure 22 Majority ethnic groups of the workers

31

Figure 23 How did you find out about the job in the
ETC?

32

Figure 24 Marital status Moyamba ETC staff

32

Figure 25 Do you have children?

33

Figure 26 Have you changed the location to work in the
ETC (Women)

33

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 7

List of Acronyms
AcF

Action contre la Faim

CHO

Community Health Officers

DERC

District Ebola Response Committee

DFID

Department for International Development

DHMT

District Health Management Team

DOTW

Doctors of the World (UK)

ETC

Ebola Treatment Center

EVD

Ebola Virus Disease

FSU

Family Support Units

IHP

International Health Partners

IPC

Infection Prevention Control

MdM

Médicos del Mundo

MsF

Médecins sans Frontieres

NGOs

Non-Governmental Organizations

PSS

Psychosocial

RC

Red Cross

SMP

Social Mobilization Pillar

SOPs

Standard Operating Procedures

StC

Save the Children

WHO

World Health Organization

8 I Moyamba District, Sierra Leone. March 2016

Purpose and Objectives of the Study
This evaluation aims to provide a gender analysis regarding Dotw/
MdM Ebola response in Moyamba ETC, Moyamba DERC “Case
Management Pillar” and all EVD guidelines and SOPs used.
The purpose is to elaborate a gender based recommendation
document for future similar interventions in communicable
diseases emergencies and to conduct a Gender workshop with
Moyamba DERC authorities to sensitize and build capacities in
gender issues.
The objectives of the evaluation are:

1. Pillar gender strategy in Moyamba EVD Response Actions:
Revision of Dotw/MdM, DERC and Case Management

strengths and weaknesses.

2. transferred to Moyamba ETC (design and activities), taking

To analyse how these strengths and weaknesses have been

into consideration admitted patients and ETC staff.

3. weaknesses, obstacles and challenges faced, providing
A short/concise report, listing the main achievements,

lessons learnt for future interventions in communicable diseases
emergencies.

4. DERC, DHMT authorities and a joint review of the final results
Design and conduct a Gender Workshop with Moyamba

of the Gender Based Evaluation.

5. authorities, partners, NGO’s related with Ebola Response,
Socialization of the evaluation results: local and national

media, etc.

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 9

EXECUTIVE SUMMARY
Sierra Leone’s first Ebola case occurred in late May 2014 and
public health emergency was declared on 31 July, worsening
the pre-existing structural, social and economic vulnerabilities in
women and girls. Due to Ebola, women and girls are even more
vulnerable than before. There has been a significant increase in
female-headed households, with a large number of dependents
and no income.
Women account for 55 to 60 percent of the deceased in the
current epidemic in Liberia, Guinea and Sierra Leone, according to
UNICEF.
As in many other infectious diseases, no specific or appropriate
treatment for female and male patients has been studied during
the Ebola outbreak. Not only sociological and gender factors have
not been taken into account in the EVD, neither the biological
differences between women and men in the medical treatment.
In this health emergency the medical side has been prioritized,
regardless of cultural, social and anthropological issues. The
influence they have in the transmission and spread of the
disease, in the recovery of patients and in their emotional and
psychological wellbeing after the convalescence have not been
taken into account.
There has been a lack of gender perspective in the Ebola
Treatment Centres (ETCs) infrastructures. Only the medical part
was taken into account to design and build the ETC: patients
were separated according their health status but not by sex, so in
the same ward there were men and women together disregarding
the cultural practices and taboos. No anthropological approach
was used for construction or later for admission of patients.
Regarding sensitization campaigns and according to some local
organizations interviewed, women were not involved either; in
summary, women participation has been very low during the Ebola
outbreak.
Data coming from WHO gives the figure of 278 Ebola cases in
Moyamba District: 149 male (53, 5%) and 129 female (46%).
The distribution of female cases has a spike between the ages
of 15-40, which correlates with the age group most associated
with caregiving in the communities. The number of female positive
cases in Moyamba surpassed the number of males by 19%.
This may be related to several causes: the limited participation of
women in sensitization campaigns, their lack of information about
how the disease is transmitted, their decision-making capacity
about whether to look or not for health care and to the fact that
they only go to the health services when the diseases is more
advanced.
Most of the employees in the ETC come from Moyamba District
and from the same chiefdoms and villages. This is clearly
related to the language challenges both patients and staff were
facing while trying to communicate ones with each other. The
communication gap has been exacerbated in the case of women,
as many of them are illiterate.

10 I Moyamba District, Sierra Leone. March 2016

37% of the women interviewed take care of their children alone
(they are single or widows) compared to only 19% of men. This
increases the burden that women already face and has not been
taken into account while planning and implementing the project;
no measures have been designed to reconcile family and working
life for them.
A large number of women said that since they work in the ETC
their work schedule had changed, meaning that many of them
have increased the number of activities as they have to perform
other cores (cleaning the house, washing clothes, ironing…) in
their free time.
Men, instead, have increased their free time or time for their
personal issues, like Internet browsing, chatting with friends,
watch TV/movies, etc.
This shows that the roles women and men were performing before
working in the ETC were perpetuated while working in it.
Most of the supervisors of the local staff were expatriates of
both sexes and only 42% of the local employees held leadership
positions, being the majority of them exercised by men (32%) and
only by few women (9,8%). The largest team, which was the IPC,
had not even a single woman in a leadership position and from the
beginning a high percentage of its members were men.
For the majority of the personnel, the main improvement due to
their work in an ETC has been the capacity building, followed by
economic improvement, professional experience and new friends
made. For women, capacity building was also highly relevant,
followed by the economic independence, which probably means
they didn’t have it before. This has been a source of conflict
between some of the female workers and their partners.
Both men and women interviewed said they were stigmatized due
to their work in the ETC by being rejected by friends and relatives,
having their money rejected at the market, not allowing their
children to play with others’ children, etc. Women said boyfriends
and husbands abandoned them arguing that they would get
infected and die; but as soon as they realized nothing was
happening and women were getting money, men came back.
Regarding the sexual harassment/violence/abuse in the ETC, staff
referred to situations of abuse of power related to supervisors,
even though no sexual violence has been reported. In the
focus groups, domestic violence experienced by female workers
arose. The psychosocial team was aware of it, and has attended
specific cases; but no specific protocol on how to deal with these
situations was put in place while the project was running.
One of the main findings of the evaluation is that women basic
access to health is minimal, depending on the authorization of the
partner/other male member of the family. Not taking into account
a gender perspective has left unattended and unprotected
more than half of the population. If we also consider the role of
caretakers of women, they and the entire family units have been
put at risk.

Women didn’t have access to basic information in an Ebola
outbreak, therefore the intervention has failed in promoting
women’s decision making related to the access to health
services, and in improving their right to health.

of similar characteristics to take gender approach into account
in order to reduce the gender gap between women and men
regarding at least the right to health.
The main recommendations are:

Similarly, and with dire consequences for the health of women,
can be said ´ the non-inclusion of women in the Surveillance
Teams. This has meant that many women that could have
matched the case definition never accessed any Treatment
Centre/ health care. 

Take into account anthropological point of view when
designing Ebola Treatment Centres and any infectious disease
intervention (separate ablutions and wards in all the zones:
white, green and red).

The evaluation results show that the burden of women has
doubled since having a fixed monthly income has not stop them
to take care of household chores, but continue to carry them out
at their leisure time. 

Promote the right to information of women to alleviate the
impact of Ebola and infectious diseases.

Regarding gender and sexual based violence, no protocols were
put in place, neither for workers nor for patients. 

Link up with local NGO’ and promote local participation to
ensure local knowledge is valued and to guarantee diversity (of
origin, religious and ethnic) when recruiting personnel.

All teams were missing gender training, both local and expatriate
and the organization did not put in place an specific policy that
would have facilitated the support and referral of vulnerable
cases and/or to coordinate with other organizations to ensure
the welfare of women and girls in their communities.
With regard to the positive impact of the intervention, it can
be said that the training of local staff has been a priority since
the beginning of the project, and the satisfaction of the workers
concerning this is reflected in their answers on the evaluation.
The trainings have not only been associated with topics related
to the work done in the ETC, but they have also been expanded
according to the demands made by the staff at the time to
organize them and carry them out. 

Ensure Women participation in all phases of the project in
order to address women needs and do it efficiently. 

Promote trainings and capacity building in all teams (local
and expatriates) including gender workshops for both men
and women; focus in highlight the burden of women’s unpaid
housework and develop strategies for improvement. Gender
awareness for women to empower them in decision making. 
Have gender sensitive staff: for privacy and protection of
women and girls and also to understand the importance
of gender issues in general and in emergency contexts in
particular. 
Ensure measures designed to reconcile family and working life
for single women with children and encourage recruitment of
women in vulnerable situations.

The quality of life of women has improved with respect to
sleep, as it has increased since they work in the ETC. Also,
precariousness has been reduced because most of the women
had, previously, informal jobs with low-wage and without
schedules. With the work in the treatment centre they have
gained organization, diversified time for each task and secured a
steady income. 

Try to ensure equal participation of women and men in all
teams and ensure that women have access to leadership
positions.

This has also been reflected in a greater autonomy of women,
as a result of a higher economic independence, which has led to
greater agency and a greater capacity decision, such as deciding
to continue with their studies or continue working, if she did not
do it before. 

Put in place a specific protocol for sexual harassment, sexual
violence and sexual abuse inside the ETC. 

Monitor the conditions of women and girls once they return to
their communities and coordinate with other organizations to
ensure that rights of women and girls are not violated. 

Recognize and compensate the unpaid effort of women taking
care of sick members of their families during the EVD outbreak.

In addition, has to be highlighted the significant effort that MdM
has done to adapt itself to the changing situation, being an
example of this the implementation of outreach activities or the
greater involvement and support to DERC and its activities as the
project progressed.
Therefore, despite everything, the project has had an impact that
can be considered as very positive for women, at least for female
workers. However, it would be desirable in future emergencies

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 11

Timeframe and Location
At the beginning the assessment was conceived to be developed
in a month and a half, but given the volume of information, it
was decided to extend this period to three months. The different
stages of the evaluation were as follows:

TEST QUESTIONNAIRE
& REVISIONS

X

INTRODUCING
QUESTIONNAIRES IN
THE DATA BASE

X

X

STAKEHOLDERS
INTERVIEWS IN
MOYAMBA

X

X

X

X

X

X

X

X

FOCUS GROUP
DISCUSSIONS
GENDER TRAINING
PSS TEAM

X

X

X
X

GENDER TRAINING
MEDICAL TEAM
DATA ANALYSIS

16 - 31

X

STAFF INTERVIEWS

STAKEHOLDERS
INTERVIEWS IN
FREETOWN

1 - 15

X

16 - 30

X

NOVEMBER DECEMBER

1 - 15

1 - 15

X

16 - 31

16 - 30

DESIGN DOCUMENTS:
TOR, QUESTIONNAIRE,
CONSENT FORM

OCTOBER

1 - 15

SEPTEMBER

X

X

X

DRAFT RESULTS &
REVISIONS

X

FINAL VERSION

X

X

The evaluation focused on the work developed in Moyamba
ETC: infrastructure, activities, the staff working in it (local and
expatriate), the patients admitted (positive or not), the relatives of
the patients or deceased patients, the beneficiary communities
and population as well as the authorities and organizations
involved in the Ebola Response in Moyamba District.

12 I Moyamba District, Sierra Leone. March 2016

Methodology
The evaluation used a mixed methodology of both quantitative
and qualitative data collection methods. Data collection was done
using desk review, surveys, informal interviews and Focus Groups
Discussions.
Desk review. It provided a full picture of the situation of the
country in terms of gender. The desk review examined issues
related to the circumstances of women in Sierra Leone before,
during and after the Ebola Outbreak, as well as the framework in
which the project took place, having in mind the laws and policies
regarding gender and the issues associated with public health
and its impact in the population, mainly in women and girls, that
could have been potentially taken into account when formulating
and while implementing the project. Literature about Ebola
outbreaks in other contexts was also reviewed, focusing mostly
on the impact of the disease in women and girls. Quantitative and
qualitative data were collected from the bibliography consulted.
Quantitative approaches. A survey (annex 1) was conducted
with the local staff working at the ETC; the total number of
employees at the time of the interview was 160 (50 women and
110 men) and of these, a stratified sample (once identified the
relevant stratums a random sampling is used to select a sufficient
number of subjects from each stratum) of 70 participated in it
(44% of total), 26 women (52% of total) and 44 men (40% of
total).

TABLE 2. NUMBER OF STAFF INTERVIEWED: POSITION,
SEX AND PERCENTAGE

ADMIN
LOG

IPC

TABLE 1. NUMBER AND PERCENTAGES OF MALE
AND FEMALE STAFF INTERVIEWED
FEMALE

MALE

TOTAL STAFF

160

50

110

TOTAL INTERVIEWS
CARRIED OUT

70

26

44

44%

52%

40%

% OF THE TOTAL

POSITION

Nº INTER- FEMALE
VIEWS

HR/ADMIN
ASSIST.

1

LOG OUTREACH

1

1

100%

DRIVER

3

3

25%

LOG ASSISTANT

1

1

100%

COOK

4

1

4

% OF THE
TOTAL

100%

40%

COOK ASSISTANT 1

1

50%

LOGISTICS
ASSISTANT

1

1

100%

STOCK KEEPER

1

1

50%

BURIAL
MANAGER

2

1

1

100%

CLEANER LR

2

1

1

50%

CLEANER VLR

1

1

25%

UNDRESSER

4

2

2

45%

WASTE
MANAGER

2

1

1

70%

PLUMBER
ASSISTANT

1

1

15%

DRESSER

2

1

1

35%

HYGIENIST

17

2

15

50%

LAUNDRY
OFFICER

4

2

2

35%

5

5

NURSE AIDE

2

1

1

70%

CHO

3

1

2

100%

PSS

5

3

2

100%

CDO

7

2

5

100%

TOTAL

70

26

44

MEDICAL NURSES

PSS

MALE

65%

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 13

All the interviews were anonymous and the consent script (annex
2) was read before the start.
Qualitative approaches. A total of 4 Focus Group Discussions
(FGD) were held, 2 of them with 4 teachers that were working
before in the ETC and the other 2 with 10 members of the
psychosocial team (PSS), that were the only ones in direct contact
with the patients, their families and relatives inside and outside the
ETC as well as in touch with the communities affected.
The FGD were divided by male and female. Some of them were
held in local languages after asking the participants in which
language they felt more comfortable.
The PSS Team was also carrying out FGD in the affected
communities, and some of their findings have been used in the
content of the assessment.
Besides this, informal interviews with key informants, local and
international NGOs present in Moyamba and with the local
authorities were conducted.
Data collection and analysis. To carry out the survey an
assistant was hired for a period of 15 days. In a period of a
week, groups of four people were completing the questionnaire
in the same place but with space enough to keep privacy. As the
interviews were anonymous, the consent script was read instead
of written and signed, and any question that arose was solved
instantly.
The questions were written in English, but after seeing the
difficulties of some of the respondents to write in English, we
decided to allow them to do it in creole or in any local language,
and to translate the questionnaire afterwards.
The second week was used for data entry, after all the interviews
were finished.
Challenges encountered. In each section there is information
regarding the difficulties encountered during the data entry and
data analysis stage, if any.
Dissemination. This report is intended for broad dissemination
within the humanitarian community and its different forums of
coordination and information. It is not subject to any restriction but
should be properly cited if referred to.

14 I Moyamba District, Sierra Leone. March 2016

GENDER CONTEXT
Beginning of the epidemic
Sierra Leone’s first Ebola case occurred in late May 2014, on the
border with Guinea. The first affected area was Kailahun district,
while the first case in Freetown was reported in mid July. The first
doctor dead was Dr. Shiekh Khan, the country’s only virologist,
who was infected while treating Ebola patients and died at the
treatment center in Kenema on 29 July.
Public health emergency was declared in Sierra Leone on 31 July
2014. Quarantine of houses with confirmed cases and outbreak
areas, restrictions on public meetings and gatherings, screening
of passengers at airports, active surveillance and house-to-house
searches were enforced. The government set aside 4th of August
as ‘Ebola Day’ in order to inspect houses, trace contacts and
quarantine suspected cases.
By early August all districts, except Koinadugu in the north, had
confirmed cases. Throughout August and September several
Ebola Treatment Centers were planned in strategic locations
throughout the country by the UK Department for International
Development (DfID), to complement the already existing centers
run by Medecins Sans Frontieres and the Red Cross.
In SL health system, most of the activities rely on women, i.e.,
nursing, cleaning, laundry, etc. Traditional birth attendants
are women, meaning they were at high risk of exposure. Also
pregnant women were at high risk because of increased contact
with health services and health workers. Two of the three largest
outbreaks of Ebola involved transmission of the virus in maternity
settings, according to the World Health Organization.
Regarding family care, when a family member is sick and is
tended at home, women cook and serve food to the sick, clean
after them and wash their clothes. This role is extended to the
medical field, where women are mostly nurses and cleaners at
hospitals and do not get the same support and protection as
doctors, who are predominantly men.
Regarding family care, when a family member is sick and is
tended at home, women cook and serve food to the sick, clean
after them and wash their clothes. This role is extended to the
medical field, where women are mostly nurses and cleaners at
hospitals and do not get the same support and protection as
doctors, who are predominantly men.

TABLE 3. CUMULATIVE NUMBER OF CONFIRMED CASES
BY SEX AND AGE GROUP IN SIERRA LEONE33
CUMULATIVE CONFIRMED CASES
COUNTRY

Sierra Leone

By sex*
By age group‡
(per 100.000 population) (per 100.000 population)
Male

Female

Both sexes

All ages
Total

All ages
Total

years

years

15 - 44

45+

4.823

5.118

1.992

5.636

2.140

0 - 14

years

Ebola outbreak has worsened the pre-existing structural, social
and economic vulnerabilities in women and girls. This situation has
been exacerbated in the case of girls who have lost their mother,
who from an early age have been doomed to assume the role of
family caregivers.
It is important to note, as done by the Oxfam Multi Sectoral
Gender Assessmen34, that women’s care role in the family
exposes not only women to the EVD infection, but the entire family
and community at large. If information on how to prevent the
infection was not accessible for them we must ask ourselves how
many members of the same family would have been exposed due
to the care giving role of women united to lack of information.
According to Sierra Leone 2013 Demographic and Health
Survey nearly one-third of the Sierra Leonean women do not
participate in any decision-making about visiting family or
relatives, major household purchases and about their own
health care35.
The same study declares that one-third of men justify wife beating
if she does things like burning the food, arguing with him, going
out without telling him or refusing to have sex with him. It also
says that more than half of women have experienced physical
violence at some point, beginning from the age of 15 onwards.
The most common perpetrators are the current husband or
partner (70%) or former husband or partner (20%). 11% of women
reported never having experienced sexual violence. Women with
an infected/survivor husband/partner are, therefore, endangering
themselves, as they cannot refuse to have sex with them.

1. WHO Ebola data & statistics http://apps.who.int/gho/data/node.ebola-sitrep.
ebola-summary-age-sex?lang=en
2. Report of the Multi Sectoral Impact Assessment of Gender Dimensions of the
Ebola Virus Disease (EVD) in Sierra Leone, Ministry of Social Welfare, Gender and
Children’s Affairs, UN Women, Oxfam, Statistics of Sierra Leone, December 2014.
3. Sierra Leone 2013 Demographic and Health Survey-Key Findings, http://
dhsprogram.com/publications/publication-SR215-Summary-Reports-Key-Findings.
cfm

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 15

There are also some traditional practices linked with the spread of
the virus like levirate and burial rites36:

Ebola Treatment Centers

“In Mende villages, no woman lacks a husband. If she is a widow
she is expected to have a caretaker husband. This husband
does not necessarily reside with the woman or in any kind of
sexual relationship. He serves as the socially recognized figure
needed for certain kinds of ritual transactions, especially those
surrounding death and burial. (…) The caretaker husband will
have to contact the relatives of the dead woman before any action
is taken. If the relatives have to come, they will be in the care of
the caretaker husband, and it is this husband who will have to
convey the corpse of the deceased to her home. So the chances
of a caretaker husband contracting Ebola are likely to be high.
(…) If women are at high risk from nursing patients with EVD
and washing widows, men have high chances of contracting the
disease in matters regarding the inter-village transfer of corpses.”

A total of 20 ETCs were functioning during the Ebola outbreak37,
from 15 up to 200 beds. They were spread all over the country.
With the aim of maximizing the response a toll free number, the
117, was enabled to report suspected cases. The Surveillance
Team was responsible of tracking calls and referring suspected
cases to the ETCs. At the beginning of the epidemic, the vast
majority of its members were all men.
Doctors of the World started talks with DfID in late August before
sending a team to Sierra Leone to assess the feasibility of running
a treatment center. Following discussions with Médicos del
Mundo, and talks with partners Solidarites International and IHP
(Norway) Doctors of the World/MDM agreed to manage the center
in Moyamba.

Moyamba is located in the Southern Province of Sierra Leone, it
“To carry out a funeral properly a number of things need to
belongs to Moyamba District and according to 2004 census38 its
happen. The corpse has to be washed, and this is thought to be
population is divided as follows:
an especial point of danger for Ebola transmission. Men wash
men’s bodies and women wash women’s bodies. The women will
include the deceased woman’s sisters, which risks spreading the
TABLE 4. TOTAL POPULATION OF MOYAMBA
Ebola virus to other lineages and (where the woman was hota,
DISTRICT BY SEX
“In-marrying women from other villages will be termed “stranger”,
hota, in Mende language) to other
villages.
LOCAL
No. of H/ H/hold
Males
Females Sex ratio Avg HH.
Special
Final
population
size
Population Population
When a man died, the wife then has
COUNCIL hold
to have her head shaved and be
Moyamba 45,223 258,506 122,366 136,140 89.9
5.7
2,404
260,910
covered with mud formed from the
District
washing of the husband’s corpse [10:
pp 94–97]. This is part of a ritual that
frees her from the attentions of the
dead husband’s jealous spirit, and prepares her to be remarried to
The official opening ceremony of the Ebola Treatment Centre,
one of his brothers, or to return to her own family. This also seems
ETC, took place on the 17th of December. Opening initially with
a likely high risk factor for Ebola transmission.”
10 beds, the first patients were admitted in the center on the
19th of December. Moyamba ETC increased its capacity up to 30
beds.
The project was an integral part of the District Ebola Response
under the direction of the District Coordinator. The decisions taken
in the center often have to be made in conjunction with DERC.
The ETC also aimed to complement the outreach activities carried
out by other partners. The main areas of coordination were
contact tracing, surveillance and follow up, as from the activities
we recognized ongoing transmission of EVD at community level
due to weaknesses in the MoH surveillance system.
Apart from the activities inside the ETC (triage, treatment and
discharge of patients, safe and dignified burial of deceased
patients) a team of 5 local psychosocial officers and one
expatriate psychologist were in charge of:

4. Social Pathways for Ebola Virus Disease in Rural Sierra Leone, and Some
Implications for Containment Paul Richards, Joseph Amara, Mariane C. Ferme,
Prince Kamara, Esther Mokuwa, Amara Idara Sheriff, Roland Suluku and Maarten
Voors. Ann M Powers, Editor.

16 I Moyamba District, Sierra Leone. March 2016

5. https://data.hdx.rwlabs.org/dataset/ebola-treatment-centers/resource/e8a9fa595068-4d2d-855e-788c63d061e8
6. S2004 Population and Housing Census, Statistics Sierra Leone, www.statistics.sl 

roviding psychosocial support for ETC patients and families by
P
taking care of the psychological health of patients admitted in
the ETC; 
onducting patients’ family tracing contact and communication;
C
facilitating their visits to the ETC whenever possible; 
ddressing fears and worries of patients’ families regarding
A
Ebola and ensuring that families and communities got the right
information in a comprehensive way involving the state of Ebola
and questions regarding EVD. 
oordination with IPC and medical teams for the discharge
C
and transfer of survivors and/or negative patients to their
communities and ensuring acceptance and reintegration.
In case of deceased patients, the psychosocial team has
been coordinating with DERC and the burial team for external
communication with families, communities and religious leaders
to ensure appropriate, safe and dignified burials.
With the objective of building capacity and keeping high
motivation of the health teams, and thanks to having different
specialists, several trainings took place at the Moyamba ETC: 
Traumatology in emergency contexts 
EVD immunology and vaccines 
EVD late complications 
Patient management 
Maternal and child health and EVD 
Triage training 
Triage training for the Moyamba District Hospital
According to the Multisectoral Gender Assessment39:

Once in the ETC, and according to the same assessment:
“Female respondents mentioned in particular (…) (they) were all
put in the same ward (without segregation and with no due regard
that some were in their menstrual cycle; some were expectant,
some were old/young and all required dignity). In their own words,
women reported “particularly mishandled, exposed and naked”.
“The tradition and morale of the typical Sierra Leonean society
was totally put asunder as male Ebola patients have no barrier
to see the nakedness of other people’s wives who are infected
by the virus. Most female survivors are reportedly sliding into
isolation, depression and a deep sense of rejection. It was also
discovered through experience sharing that some survivors,
especially female, are easily losing their temperament due to
mockery from immediate relatives and community people”.41
Most of the masons and staff dedicated to the ETC construction
were men, however, for the construction of Kenema (Red Cross),
Kissy (MsF) and Hastings (MsF) women were included for
architectural design and indications in construction.
In Kenema a lot of men were hired for qualified works while
women were participating in the non-qualified ones: bringing
sand, water, etc. In Hastings and Kissy all the local staff involved
in the construction were men.
According to experts consulted, this is because the stigma
suffered by women was higher and there was less social
acceptance for them to work in an ETC: as women are
traditionally responsible for the home care if they work in an ETC,
they should leave these activities to others.
In all the analysed ETCs the wards were mixed, and only in Kissy
there were curtains to separate the spaces between males and
females. In the other centres screens were used when needed to
wash a patient or for the preparation of the deceased.

“From the respondents (…) almost all Ebola female survivors’
negative and traumatic experiences shared were related to the
processes of their extraction from their families when the rapid
response teams arrived in their homes to transfer them to holding
or treatment centers (…). Female and male survivors narrated how
inhumanly they had been handled by the rapid response teams.
They narrated how ambulance teams did not even explain to them
why and where were they being taken”.

As reported by participants in focus group discussions, this
measure was insufficient to ensure the privacy and dignity of
patients.

This posed a major problem to detect suspect cases in women,
since they were either not reported or their husbands neither
themselves allowed male members of the Surveillance Team to
enter their homes. This coupled with the lower access to health
services for women meant that the number of female infected
patients has been greater than in the case of of men, and that
their health status on arrival at ETC was more serious.40

Regarding the dignity of patients inside some of the ETC’s, it has
been remarked the lack of separated ablutions, toilets privacy
screens and safe disposal bins for used sanitary items for women
and girls42. None of the centres evaluated had any safe disposal
bins for used sanitary items for women and girls, nor a specific
place for washing fabrics used in their menstruation.

7. Report of the Multi Sectoral Impact Assessment of Gender Dimensions of the
Ebola Virus Disease (EVD) in Sierra Leone, Ministry of Social Welfare, Gender and
Children’s Affairs, UN Women, Oxfam, Statistics of Sierra Leone, December 2014.
8. See figures 19 and 20 of this study.

In the case of the toilet facilities, they were mixed. It seems that in
some ETCs they’ve tried to separate them (i.e. Kissy) but nobody
placed signs specifying whether they were for men or women
therefore the measure was not effective and both used both toilets.

The first center with maternity ward was Kailahun (Msf), opened
in June/July 2014. In January 2015, MsF too, opened a center,

9. Ibid.
10. IASC (Inter-Agency Standing Committee), Reference Group for Gender in
Humanitarian Action: Humanitarian Crisis in West Africa (Ebola). Gender Alert:
February 2015.

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 17

FIGURE 1. WARD IN KISSY MATERNITY (MSF).

FIGURE 2. WARD IN MAGBURAKA (MSF).

18 I Moyamba District, Sierra Leone. March 2016

FIGURE 3. WARD IN GODERICH (EMERGENCY).

FIGURE 4. WARD IN KERRY TOWN
(SAVE THE CHILDREN).

FIGURE 5. DEAD BODY MANAGEMENT INSIDE
THE WARD IN KENEMA (RC).

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 19

Kissy, the first one with specialized care for pregnant women
infected by Ebola or suspected to be infected. The center had
different areas for suspected and confirmed cases. There were
several proposals in other MsF ETCs for a triage only for pregnant
women to avoid long waits for women with gynecological
problems, but none was carried out.
In Kenema, Red Cross launched the Pediatric Observation Unit
for non-positive children with their parents admitted or dead and
nowhere to go. Male and female survivors attended them.
In general, children admitted in the ETCs were mostly cared for by
women: survivors, patients or a relative; although in some cases
there were men, this was not the general trend.
Regarding the admission and treatment of patients according to
the Multi Sectorial Gender Impact Assessment:
“In the case of Sierra Leone, women who were expectant or in
their menstrual cycle (…) at the time of their extraction from their
homes and referral to EVD holding centers were treated as if they
were confirmed cases of EVD (simply because of the bleeding).
This caused tremendous psychosocial anguish in the sense of
unjust suspicion form EVD”.
As well as the fact of having mainly men in the Surveillance Team,
this degrading treatment of women did not help them to approach
the ETCs.
It is also known that there have been cases of sexual violence
in certain ETCs, as it was expressed in informal chats with key
informants and also shown in different assessments:
“In the case of Sierra Leone, women who were expectant or in
their menstrual cycle (…) at the time of their extraction from their
homes and referral to EVD holding centers were treated as if they
were confirmed cases of EVD (simply because of the bleeding).
This caused tremendous psychosocial anguish in the sense of
unjust suspicion form EVD”.43

Implications for women
and girls
Women account for 55 to 60 percent of the deceased in the
current epidemic in Liberia, Guinea and Sierra Leone, according to
UNICEF.
The impact on women has economic implications. In rural areas,
where the majority of smallholder farmers are women, food
production was affected. Border restrictions affected traders,
the majority of whom are women, making it difficult for them to
provide for their families. Women are in the frontlines of this crisis.
According to UNICEF, only 52% of girls aged 15-24 are literate,
compared to 70% of boys44, and as reported by Sierra Leone
2013 Demographic and Health Survey45, more than half of women
have experienced physical violence since age 15 and 11% of
women have suffered sexual violence.
The Children’s Ebola Recovery Assessment46 says that, during
the Ebola crisis, sexual violence against girls has increased across
all districts, being reported also attacks on girls in quarantine
households. By what is reflected in the study, there was also an
increase in transactional sex, used to cover basic needs among
vulnerable girls, especially those affected by the loss of relatives
to Ebola. Children declared this is one of the several factors
contributing to increases in teenage pregnancy.
The assessment talks also about exploitation of young girls, with
little idea about sex and more vulnerable to be victims of abusive
and exploitative relationships; Amnesty International expresses the
same concern in their report:
“Pregnancy amongst young girls is often a consequence of other
rights violations, including coercion and/or sexual violence and
rape, lack of information related to girls’ sexual and reproductive
health and rights, and harmful cultural practices such as early
marriage. The Ebola crisis has exacerbated the already existing
inequalities and vulnerabilities of girls to violence”.
Another survey conducted by Defence for Children47 had similar
conclusions: increase in violence levels and sexual exploitation
relationship with dire consequences for girls.

12. Shamed and Blamed: Pregnant Girls’ Rights at Risk in Sierra Leone, Amnesty
International, 2015.
13. Sierra Leone 2013 Demographic and Health Survey-Key Findings, http://
dhsprogram.com/publications/publication-SR215-Summary-Reports-Key-Findings.
cfm
14. Children’s Ebola Recovery Assessment: Sierra Leone, Save the Children, UNICEF,
Plan, World Vision, March 2015.

11. Rapid Gender Assessment Report of the Ebola Response in Sierra Leone’s
OXFAM Operational Areas, Dr. Fatmatta Taqi, 12th January 2015.

20 I Moyamba District, Sierra Leone. March 2016

15. A Mountain to Climb. Gender Based Violence and Girl’s Right to Education
in Sierra Leone, Defence for Children International, May 2015, http://www.
defenceforchildren.org/wp-content/uploads/2015/06/GBV-and-Girls-Right-toEducation-in-Sierra-Leone_May2015_EN.pdf

In the district of Moyamba, the increase of teenage pregnancies
is quite significant. According to the data provided by the
Psychosocial Pillar the number of pregnant girls in 2013 was of
1.927, while in 2014 there were 2.424. In some of the chiefdoms
the increase has been more than 100%:
TABLE 5. TEENAGE PREGNANCIES IN MOYAMBA
CHIEFDOMS
CHIEFDOM

Pregnant Teens

Pregnant Teen

2013

2014

% Change

Ribbi

141

144

2,1

Fakunya

166

260

56,6

Dasse

126

94

(25,4)

Lower Banta

230

283

23,0

Upper Banta

74

126

70,3

Kamajie

35

48

37,1

Kowa

77

55

(28,6)

Kaiyamba

240

237

(1,3)

Kori

264

285

8,0

Bagruwa

90

115

27,8

Timdale

94

75

(20,2)

Kargboro

168

342

103,6

Kongbora

58

126

117,2

Bumpeh

164

234

42,7

TOTAL

1.927

2.424

25,8

During the Ebola outbreak the health system, already weak,
was badly affected; women and girls’ access to sexual and
reproductive health services, information and goods, including
post rape health care was virtually non-existent.
It seems that there were also some issues related with the military
in charge of quarantine houses: they were only men, as well as
police officers, and this is a concern shared by different people
interviewed as well as for the local NGOs, that asked about the
possibility of having female security forces in the quarantined
households. Some expressed concern at the lack of gender
awareness by the military, aggressiveness and even harassment
of women and girls in the communities, as it was reported by the
press that an underage girl had been raped by one of the security
personnel in a quarantined house.
When the state of emergency was declared in the country
quarantine was imposed in all the households affected by the
virus. This was done without a previous assessment of the
household needs and without provision of supplies. As a result,
women and girls were forced to negotiate with the security forces
stationed to guard their houses to get out and fetch water or
firewood to prepare food. This negotiation could be anything from
money to any kind of returning favor, including sexual ones.
There are almost no allegations of violations as cases are kept
within the communities. In Moyamba only a couple of cases
have been reported: a sexual attack of a quarantine house in
Ribbi and a survivor asked for a sexual favor when looking for
accommodation.
This is related to fear and lack of access to justice: some of
the perpetrators are prominent people in the community and
there is only one magistrate for Moyamba and Bonthe Districts.
Women and girls get tired of waiting and spending money (they
have to pay for transport, food and accommodation to go to
Moyamba and follow the issue) and of being marginalized in their
communities.

FIGURE 6. INCREASE OF TEENAGE PREGNANCIES
IN MOYAMBA DISTRICT
2.500

2013

2014

2.000
1.500
1.000
500
0

Pregnant
Teen Girls

Pregnant
and Married

Pregnant
Out of School

Pregnant
& in School

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 21

Medical approach
As regarding many other infectious diseases, no specific or
appropriate treatment for female and male patients has been
studied during the Ebola outbreak. Clinical trials have included
only males, and in those including both males and females no
distinction was made between them in the analysis.48
Not only sociological and gender factors have not been taken into
account in the EVD, but also the biological differences between
women and men in the medical treatment.
Understanding the role gender plays in an Ebola epidemic is
crucial so that communication and intervention strategies can
be better targeted. Women play a major role as conduits of
information in their communities, and therefore they are being
enlisted as leaders in campaigns to spread awareness about the
disease.

16. Addressing sex and gender in epidemic-prone infectious diseases. WHO, 2007.

22 I Moyamba District, Sierra Leone. March 2016

FINDINGS
Infrastructure
The aim is to analyze whether the Ebola Treatment Center in
Moyamba took into account the gender approach in its design,
if the spaces were outlined thinking that men and women will
occupy them and considering also, as far as possible, customs
and/or local taboos, which could be crucial when making a patient
feel more or less comfortable and seeking to avoid possible
situations of vulnerability for women and girls.

Moyamba ETC is divided into three main areas: White (or Very
Low Risk), Green (Low Risk) and Red (High Risk). While in the
first two sections the toilets along with the changing rooms were
gender friendly, that is, separated by sex, that was not the case in
the Red Zone.
In the High Risk area there were 6 big tents: Suspected (one tent),
Probable (two tents), Confirmed (two tents) and Convalescent
(one tent). All tents were mixed and so were the bathrooms.

DFID funded 6 ETCs in Sierra Leone: all of them were designed
by the Royal Engineers, who also overseed the construction,
completed in part with the Ministry of Defense and local
contractors.

This fact, which may seem insignificant, is not. In health
emergencies the medical side is prioritized, regardless of cultural,
social and anthropological issues and the influence they have
in the transmission and spread of the disease as well as in the
recovery of patients and in their emotional and psychological
wellbeing after the convalescence. In this case, only the medical
part was taken into account to design and build the ETC: patients
were separated according their health status but not by sex, so in
the same ward there were men and women together disregarding
the cultural practices and taboos. No anthropological approach
was used for construction or later for admission of patients.

Engineers of 62 Works Group Royal Engineers and of the
Republic of Sierra Leone Armed Forces worked during the
construction of the Moyamba Ebola Treatment Centre. They were
all men, as well as most of those who were involved in the design.

This evidence also emerged in the evaluation, where the answers
given to the question Do you think the ETC was respectful with
the customs of the population? were mostly positive, saying the
ETC was, in effect, deferential with the habits of the community.

FIGURE 7. AERIAL PHOTO OF EBOLA TREATMENT
CENTRE, MOYAMBA.

FIGURE 8. MOYAMBA ETC MAP.

Likewise, it has also considered whether the design was done by
men, women or both and the possible consequences of this fact.
Finally, we have analyzed other designs and consulted various
experts to get an overview of the infraestructures used during the
outbreak and their gender perspective, if any.

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 23 

OES THE ETC RESPECT
FIGURE 9. D
LOCAL CUSTOMS?

FIGURE 10. CHALLENGES FOR MALE AND FEMALE
PATIENTS INSIDE THE ETC.

Men 45-65

Staff working
in not culturally
apropiate jobs

NA
NO
YES

Woman 45-65

Male
Female

Lenguaje

Men 35-45
Woman 35-45

Staff of the
opposite sex

Men 25-35

Mixed Wards /
Little Privacy

Woman 25-35
Men 18-25

Mixed Toilets

Woman 18-25
0

05

10

15

20

Out of 69 respondents 47 answered affirmatively to the question,
19 women and 28 men. A total of 8 answered negatively, 2
women and 6 men, and 14 did not answer the question, 6
women and 8 men. Those few who answered NO referred to
discrimination and “lack of observance of cultural values”.
However, in the next question, about the challenges for male and
female patients inside the ETC, the answers clearly show that,
somehow, the ETC was not so respectful with matters considered
very relevant for the staff, as lack of privacy or mixed wards for the
sick.
While responses to the questionnaire showed that the cultural
approach was more or less adequate, the focus group
discussions evidenced that some of the issues regarding
the lack of respect for local customs mentioned briefly in the
questionnaires were really important at social and cultural level.
Some of the statements in these FGD were: 
People felt ashamed

0

05

10

15

20

Patients interviewed agreed that the ETC was respectful towards
local customs and the staff treated them properly. However, there
were comments like: “The ETC was somehow respectful to us,
even though we have no option but to accept whatever we are
told to do. You know, when somebody is close to die, you have to
forget about tradition”.
It seems that, by prioritizing the medical aspect, the part
concerning the dignity of patients remained in the background,
and quite sensitive aspects to women such as nudity or
menstruation were underestimated.
Regarding the matter of sexual harassment, violence or abuse, in
interviews to Moyamba ETC staff both through questionnaires and
informal interviews, everyone denied such possibility:

FIGURE 11. DO YOU THINK THERE WERE CASES OF
SEXUAL HARASSMENT/VIOLENCE/ABUSE
INSIDE THE ETC? 

ETC has no respect for the customs of the population 
here were female patients with children and the nurses were
T
putting a catheter to an old man, the children were playing
around… it is shameful

YES

T 
here were a lot of patients per tent (10), it should be reduced:
2 to 5 
creens block the view while cleaning a patient but it is not
S
enough. Patients are confused and they move around.
T 
o have a father and a daughter in the same ward, him half
naked… Also a brother that sees sister’s nakedness… it is a
taboo
( Male patients) because of the seriousness of the virus, most
of them do behave abnormally and in such cases they pay no
privacy to women inside the ETC

24 I Moyamba District, Sierra Leone. March 2016

NO

0

10

20

30

40

50

60

70

Out of 64 respondents only 4 answered YES, when asked:
What do you think could be done to avoid these situations? The
comments were imprecise:
Counsel their staff to improve us
Encourage people to come forward
To continuously create and make by laws to avoid it
Probably the question was very direct, the issue was extremely
sensitive and time was not enough. So, in case of wanting to
delve into such a sensitive issue it is recommended to devote an
assessment just for that topic, and having local people involved
in its implementation, previously explaining what is meant by
harassment/abuse/violence.
Challenges encountered: 
Even if the questionnaire was tested before, it is clear that some
of the questions (“Do you think the ETC was respectful with the
customs of the population?”, “Do you think it is possible that
there were cases of sexual harassment/violence/abuse inside
the ETC?”) were too open or vague. 
t the time of the data collection, most of the ETCs were
A
already closed or were being dismantled so it was difficult to get
interviews with the persons in charge.

AWARENESS RAISING,
CASE DETECTION AND
TRANSFER TO THE ETC
The Social Mobilization Pillar was in charge of awareness of the
population on Ebola and health promotion. It is a key actor since
its main function is to sensitize and inform the community about
transmission modes of the disease, what to do if someone has
symptoms, and to inform about the work of the ETC.
There were 5 social mobilization groups per chiefdom, with a
DHMT supervisor and key role players involved (paramount chiefs,
traditional healers, etc.). These groups were not gender balanced
fromthe beginning of the epidemic and according to the key
informants interviewed “women were afraid of Ebola”, but little by
little they were trying to involve them.
There were different activities carried out to sensitize the
communities:
Radio programs and radio discussions. 
own “criers”; in catchment villages, someone with a
T
microphone “crying” the key messages.

I nclude the anthropological point of view in the design of the
ETC and upcoming emergency/ebola health settings 

ey role players; i.e. female groups in every community, even
K
if they were not strong enough, they were involved using
the influence of the paramount chief, CHOs and/or social
mobilization volunteers. 

omen should participate in all phases of the project: women
W
needs will not be covered if they are not actively involved 

en societal heads; to advise the population not to wash
M
bodies, etc.

I t is important to involve local staff as much as possible (female
and male) in the design and management of the ETCs, since
they know social and cultural dynamics and we can find
alternatives together to accommodate local customs 

Momma/Mommy queens; female leaders.

Recommendations: 

o advocate for segregated wards and the integration of
T
gender specific interventions into Ebola Response activities and
stakeholders involved 
here should be separate toilet facilities in ETCs/health facilities
T
to guarantee privacy and security for women and girls
BEFORE, DURING AND AFTER ETC ARRIVAL
The project is an integral part of the District Ebola Response
under the direction of the District Coordinator. The ETC also
aimed to complement the outreach activities carried out by other
partners. The main areas of coordination were contact tracing,
surveillance and follow up, as it was recognized possible ongoing
transmission of EVD at community level due to weaknesses in the
MoH surveillance system.
The activities analyzed in the study were only those carried out
in the ETC: triage, treatment and discharge of patients, safe and
dignified burial of deceased patients; but also the relation of such
activities with those others carried out by other actors involved in
Ebola Response. 

ambutok groups; they were trained by NGOs like ActionAid,
F
etc. to act as mediators, to solve problems in the community. 
Motorcycle/motorbike riders 
Religious leaders 
aternal groups; they used to go to the clinics for antenatal and
M
under 5 care
However, they found quite a few problems to involve women. It
was difficult to meet them, as they were afraid of health workers,
especially at the beginning of the outbreak, because of certain
myths and legends spread about the disease (i.e. people stealing
blood) and because most of the Ebola outbreaks have started
in health facilities or have health workers involved in them (as
they are in the frontline they get infected in first place when the
epidemic is just beginning). Also, the timing and location of the
meetings were agreed regardless the schedules of women, who
were farming or too far to attend.
It must be said that not all women have access to radio or
understand all the languages in which awareness campaigns were
conducted. All the town criers were men, thus, the presence of
women was greatly reduced by this fact. The messages that were
launched at the beginning were not adequate, as it was said that
Ebola was deadly and no one could be cured, this makes people

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 25

refuse to go to ETCs. Fortunately they quickly realized the error
and messages were changed.
The Initial Analysis of Moyamba Ebola Treatment Centre Data
done by the Public Health Advisor based in Moyamba affirm
that the ETC saw only 14.8% of the total recorded Ebola
cases in Moyamba. This reflects the fact that while active case
management is a vital component of any outbreak response,
much of the work to bring the epidemic to an end happened
outside of the ETC and therefore it’s vital to involve community
members, including women at early stages.
It seems that another problem was the initial lack of coordination
and communication between the NGOs working in the response
to the outbreak and the Social Mobilization Pillar. According
to those interviewed, this was the case of MdM, who came to
coordinate with them near the end of the project. It would have
been good taking the Social Mobilization Pillar advice when
recruiting personnel; for example, having staff from different
communities would have been an asset.
According to some local organizations interviewed, women were
not involved in sensitization campaigns and their participation was
low during the Ebola outbreak as mainly men were implicated in
them:
“Women are more at risk and they don’t have information. As
caretakers they are more affected. Information was not reaching
women: they are not educated, they don’t have radios or they
don’t have the time to listen to the radio. Also the coverage for the
radios is not good in the whole district”.
“Sensitization was not reaching all the areas and all the
population. At the beginning, information about the ETC was not
reaching everybody. The first message was wrong: “If you get
Ebola, you will die”, “Ebola is incurable”, and so they were not
reporting the cases”.
“Community people are required to translate the messages in
local languages”.
“In communities like Ribbi, women didn’t know about sensitization
campaigns”. This statement is highly relevant as the larger number
of patients received in the ETC came from Ribbi: out of 106
patients337 60 were from Ribbi, 25 female and 35 male, 27 were
positive, 14 female (8 survivors) and 13 male (2 survivors). A total
of 45% of the patients from Ribbi were tested positive, 56% of
women and 37% of men.
The number of female positive cases surpassed the number of
males by 19%, despite the number of male patients coming from
Ribbi is higher. This may be related to the limited participation of
women in sensitization campaigns, their lack of information about
how the disease is transmitted, their decision-making capacity
about whether to go or not to the hospital (or, in this case,
whether to call or not to 117) and the fact that they go to the
health services only when the diseases is more advanced.

17. From the date of opening to the date of closing as ETC, 31st March 2015.

26 I Moyamba District, Sierra Leone. March 2016

FIGURE 12. ETC ADMISSIONS PER CHIEFDOM
Kangboro

2

Bagruwa

1

Kori

1

Lower Banta

1

(blank)

1
60

Ribbi
Moyamba City

1

Moyamba

1

Kongbora

1

Kargro

2
30

Kalyamba
FakumYa

1

Bumpeh

4
0

10

20

30

40

50

60

70

FIGURE 13. PCR RESULTS PER CHIEFDOM
Kangboro

0%

Bagruwa

0%

Kori

0%

Lower Banta

0%
0%

(blank)
Ribbi

45%

Moyamba City

0%

Moyamba

0%

Kongbora

0%

Kargro

0%

Kalyamba

17%

FakumYa
Bumpeh

0%
25%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Local NGOs were reporting also a lack of general knowledge
about Ebola at the beginning of the epidemic, as men didn’t allow
women to go out and/or to join sensitization campaigns.
A serious problem was that, at the start, all contact tracers
and burial team staff in the district were men; this made the
population reluctant to call 117 if the person with symptoms was
a woman: it is not culturally appropriate for a man to see a woman
without clothes, or having diarrhea, etc… As reported by these
organizations, the problem was that the Ebola Response was
organized without relying on female organizations and women
were scared of participating in it. After some advocacy was done
by such female organizations, more women were involved.
The Surveillance Team was aware of this problem and in late
October 2014 AcF supported them with 5 female ambulance
nurses. In November/December 2014 3 female surveillance
officers joined the team (out of 25 male surveillance officers in
the whole district). In December 2014 female members started

Something that was stressed as positive was the incorporation
of local NGOs, with roots in the field, in the PSS Pillar and in the
DERC, to pass the message and improve the sensitization. This
happened in September 2014.

FIGURE 15. MALE EBOLA CASES IN MOYAMBA DISTRICT
14
12
10
Number of Cases

working in the burial team too. Apparently this supposed a
clear improvement and none of the patients and/or survivors
interviewed for this evaluation have referred to this fact.
It has also been reported that people were scared of ambulances
and chlorine overuse, and even the death of a patient after
being sprayed and put into the ambulance and transferred to
the treatment center. However, apparently this was at the very
beginning of the outbreak and with awareness campaigns, fear
was diluted.

8
6
4

All persons interviewed agreed that it is essential to ensure that
women are involved in all the areas: medical, PSS, contact
tracing...

2
0

“Women have to take part, to be involved”.

0 05 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age

“People trust women, mainly other women. Women and children
are good in disseminating messages in the communities, they
have to be involved”.
According to WHO it is difficult to find qualified women in the
depressed districts but it is impossible to address women issues
if only men are engaged as community mobilizers because “50%
of the population is left out. The composition of the teams is highly
relevant”.
Data coming from WHO gives the figure of 278 Ebola cases in
Moyamba District: 149 male (53, 5%) and 129 female (46%) EVD
cases. The distribution of female cases has a spike between
the ages of 15-40, which correlates with the age group most
associated with caregiving in the communities.

found that, in terms of mortality, men were significantly more
likely to die from EVD than women. A man had a 25% chance of
surviving Ebola (holding age and symptom duration constant),
while a woman had a 42% chance survival (with the same age/
symptom duration). This may well be because men were more
likely to contract EVD during burial practices and it might be that
post-mortem transmission is more virulent and dangerous than
EVD transmitted through care-taking behavior.
In line with Moyamba ETC statistics until 1st April 2015 the
majority of the admitted patients were male (60%):

The research done by the Public Health Advisor in Moyamba

FIGURE 14. FEMALE EBOLA CASES IN MOYAMBA DISTRICT

FIGURE 16. ETC ADMISSIONS BY AGE AND GENDER

14

45
40

12

Male

Female

40

35
Number of Cases

Number of Cases

10
8
6
4

30
25

25

20
15
10

2
0

5
0 05 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Age

0

7

6
<5y

9
5

3

2

6-17y

18-60y

>60y

Age

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 27

Yet, it is interesting to note that most of the women treated were
tested positive:

Once a suspected case was reported it was subjected to triage,
first by the Surveillance Team and then by the staff at the ETC. In
most of the cases someone from the community called the 117 to
inform about the possible case.

MALE

FIGURE 17. PCR RESULTS BY GENDER

FEMALE

25,00%
40,48%
0%

10%

20%

30%

NEG (group)

40%

50%

60%

70%

80%

90%

100%

POS - POS

This can be related with socio-cultural factors that, taken from a
gendered perspective, show that decision-making is crucial when
we talk about EVD infection, prevention and access to adequate
treatment. A woman would not look for health care without the
consent of the husband or the man head of the household.
The vast majority of the interviewed Moyamba ETC female
survivors said that their husbands or male heads of household
(sons, brothers...) were the ones making decisions about their
health and that of other family members.
Other informants related the low access to health care by women
in polygamy, stating that if one of the wives get sick, it’s her
parents and/or relatives the ones in charge of taking care of her,
either taking her to the original home or calling 117 in case of
need; also, only one of the women is the “favorite” and the others
will have limited resources for their needs.
Challenges encountered: 
ack of coordination between MdM and the Social Mobilization
L
Pillar at the beginning of the project 
ack of time to visit some of the women groups active in the
L
communities before, during and after the Ebola outbreak
Recommendations: 
o promote women’s right to accessing information to alleviate
T
the impact of Ebola. 
To guarantee the participation of women in awareness rising. 
o link up with local NGO’s through the Social Mobilization Pillar
T
to promote women involvement. 
o recruit gender sensitive staff and/or build their capacity on
T
gender issues: both for privacy and protection of women and
girls; and also to understand the importance of gender issues in
general and in emergency contexts in particular 
o be flexible to change the project strategy to ensure that it
T
suits women needs.

28 I Moyamba District, Sierra Leone. March 2016

TRIAGE & TREATMENT

The forms used both by the Surveillance Team (annex 3) and
by the ETC (annex 4) have disaggregated data by sex and
age but, for example, none of them asked about menstruation
when asking about bleeding and they refer only to “unexplained
bleeding”.
None of the triage forms leaves room to report possible cases of
abuse and to keep track of them and/or refer to the psychosocial
team. This could have been updated in the case of the form used
in the ETC due to the alarming data on the number of cases of
women and young girls who were victims of abuse in homes in
quarantine, for example.338
It seems that the reception of patients from the ambulance to
triage was done too slowly and patients were kept waiting for a
long time inside the ambulance under the sun, sometimes several
patients in the same ambulance at a time.
Although no kits for menstruation were provided to women
and girls, they were given sanitary towels whenever they need.
Given the fact that in Moyamba there was not a high occupancy
of the wards, privacy was more or less guaranteed (although
it depended on the gender sensitivity of the nurse on duty).
However, in other ETCs with higher bed occupancy rates, this
would be almost impossible.
With regard to the patient management once the person was
admitted, as maintained by the staff interviewed, the fact of being
treated by health workers of the opposite sex was challenging
for some patients, and so it was for part of the staff, as shown by
some of their answers to the questionnaire:
It was hard for men to help a woman, mostly when they are
not in love (…) Same for a woman, (she) should not help a
man who is not her husband 
hey (male patients) think we are here (female nurses) to
T
create love instead of our duties
(Female staff) find it difficult to change dressings with
diarrhoea, cause of sex some will not accept 
To have a female nurse or doctor treating a male patient and
vice versa, it was a problem
As shown in figure 6, another major problem was the
communication difficulties related to language: 4 of 17 women
and 4 of 25 men affirmed that language was a clear barrier
between patients and ETC staff. It was hard for the patients

18. Children’s Ebola Recovery Assessment: Sierra Leone, Save the Children,
UNICEF, Plan, World Vision, March 2015
Shamed and Blamed: Pregnant Girls’ Rights at Risk in Sierra Leone, Amnesty
International, 2015

from different tribes to understand the local staff, which mostly
belonged to the same tribe.

DISCHARGE

There were also some concerns about women and men
performing works considered unsuitable for them because of their
sex and patients’ rights:

In case of deceased patients, the psychosocial team has
been coordinating with DERC and the burial team for external
communication with families, communities and religious leaders to
ensure appropriate, safe and dignified burials.

Hard work for female, i.e. doing the same work as men 
en doing the work of women, i.e. laundry, assistant in
M
cooking and cleaning 
As long as you are a patient you don’t have any right
All admitted patients and their relatives had the possibility to
appeal to the psychosocial team, in charge of: 
roviding psychosocial support for ETC patients and families
P
by taking care of the psychological health of patients admitted
in the ETC; 
onducting patients’ family tracing contact and
C
communication; facilitating their visits to the ETC whenever
possible; 
ddressing fears and worries of patients’ families regarding
A
Ebola and ensuring that families and communities got the
right information in a comprehensive way involving the state of
Ebola and questions regarding EVD.
Challenges encountered: 
one of the expatriate doctors who were in Moyamba ETC at
N
the time of the investigation had worked with positive patients,
and they did not have the information to answer some of the
questions.
I t will be highly desirable to interview more patients in the
communities but this was not possible due to lack of time and
lack of a support team to do it. 
o gender perspective at all in most of the staff, either local or
N
expatriate.
Recommendations: 
Recruit gender sensitive staff and/or build their capacity on
gender issues: for privacy and protection of women and girls
and also to understand the importance of gender issues in
general and in emergency contexts in particular 
o ensure that there is no loss of information by creating
T
appropriate protocols for transferring it to other expatriates 
Flexibility to change the project strategy so it suits womens’
needs 
ake into account knowledge of local staff to improve the
T
treatment of patients 
To value local knowledge

In some of the ETCs, to prepare the dead body of the opposite
sex produced discomfort in the local staff. As already mentioned
above, only men formed burial teams, which was a problem at
the beginning of the epidemic. This was partially solved with the
incorporation of some women to the team. In Moyamba ETC the
burial team had, since the beginning, one woman in the team.
The psychosocial team, in coordination with IPC and medical
teams, was also responsible for the discharge and transfer of
survivors and/or negative patients to their communities ensuring
acceptance and reintegration.
All patients leaving the ETC received a kit, which varied
depending on whether or not they were survivors. There were
several organizations providing kits to EVD affected people and
to quarantine houses too. Common complaints were lack of
sanitary napkins, undergarments, towels and clothing for women
and infants in the kits. Oxfam is the only organization consulted
that was giving kits with a gender vision, with sanitary materials in
them and using non transparent plastic bags.
Some of the key informants interviewed said the support given
to Post Ebola Recovery Programme was not well coordinated,
i.e. packages given to survivors or EVD affected people were not
standardized, survivors and orphans were receiving support while
widows, as vulnerable as the others, were not.
Several of those women’s organization in Moyamba that were
interviewed for the research even mentioned cases of arranged
“sexual intercourses” organized by the families of the woman or
girl, in exchange of a favor from the perpetrator, which is usually
an influential person in the community. This makes very difficult
to follow the case since the victim’s family is involved. This seems
to be a “normal” practice, but due to the Ebola women and girls
are even more vulnerable than before and they are more likely to
be exposed to this type of situation. Some of the organizations
consulted linked this with the increment of teenage pregnancy.
There has been also a significant increase in female-headed
households, with a large number of dependents and no income,
since most of the breadwinners had died, clearly exacerbating
their vulnerability. Some of the women reported they lost their
houses (chased out in most of the cases) and they were forced to
move into relatives’ homes.
All these factors should be taken into account at the time of
discharge of patients. Considering that the only team in the
project related both with patients and their families as well as
with their communities was the psychosocial team, it is highly
recommended to monitor the conditions of women and girls once
they returned to their communities and to coordinate with other
organizations to ensure that the rights of women and girls are not
violated.

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 29

Challenges encountered:

FIGURE 18. AGE AND STUDIES OF THE STAFF INTERVIEWED 

he high rate of expatriate staff rotation has meant that
T
information is lost or is not found as quickly as expected

18

I t will be highly desirable to interview more patients in the
communities, but this was not possible due to lack of time and
lack of support team to do it.

16 

o gender perspective at all in most of the staff, either local or
N
expatriate.

12

Recommendations: 
ecruit gender sensitive staff and/or build their capacity on
R
gender issues: for privacy and protection of women and girls
and also to understand the importance of gender issues in
general and in emergency contexts in particular 
o monitor the conditions of women and girls once they
T
returned to their communities and to coordinate with other
organizations to ensure that the rights of women and girls are
not violated. 
o recognize and compensate the unpaid effort of women
T
during the Ebola outbreak, taking care of sick members of their
families by valuating it socially and economically

Staff
At the time of the assessment, the local staff in the ETC were 160
people, 68% of them were men and 32% women: 110 men and
50 women. Interviews were a total of 70, 26 women and 44 men.
At the date of the opening, 16th December 2014, the local staff
were 240 people, 70% of them were men and 30% women: 170
men and 70 women.
Regarding the expatriates, since the beginning of the project
there have been 110 expatriates, 53 women and 57 men.
Figures here are much more compensated than in those of local
personnel.

EDUCATION
The level of education of the local staff varies depending on the
position they hold: in age range between 25-35 years there is the
largest number of people with university education, a majority of
them men. It should be noted that most workers have at least
secondary education, regardless of gender.

Primary
Secondary
College/Univerity
Other

14

10
8
6
4
2
0

MEN

WOMEN

18-25 years

MEN

WOMEN

25-35 years

MEN

WOMEN

35-45 years

MEN

Challenges encountered: 
hort time frame to test the questionnaires, do the interviews
S
and to input the data. 
Support team only available for a few days. 
ecause of this there were up to 6 people in the same room
B
filling (individually) the questionnaires, which it is not ideal. 
ome supervisors didn’t want the participants to fill the
S
questionnaires in working hours, so the staff was extending
their workday to participate. 
ome people were not confident answering/writing in English,
S
so they were answering in creole and later had to be translated
into English. 
Some of the questions were too sensitive and others were not
properly formulated, so it is likely that the information in this
aspect could be biased or incomplete.
Recommendations: 
Prioritize educated women rather than men because there are
fewer of them. 
ry to ensure equal participation of women and men in all
T
teams. 
Promote trainings and capacity building in all teams.

30 I Moyamba District, Sierra Leone. March 2016

WOMEN

45-60 years

ORIGIN

FIGURE 21. CHIEFDOMS IN MOYAMBA STAFF
IS COMING FROM

When we analyze the origins, we see most of the employees are
coming from Moyamba District:

30

25

FIGURE 19. DISTRICTS STAFF IS COMING FROM
20

70
60

15

50

10

40

5

30

BO

KENEMA

MOKOREWO

MORTHANKIL

YOYEMA

SEMBEHUN TOWN

SEMBEHUN

NYANDEHUN

MOYAMBA TOWN

0

MOSTINRGOR

10

KAIYAMBA

20

WATERLOO

MOYAMBA

0

MOYAMBA

This is not surprising given the ETC is located there, even if the
vacancies were advertised in the whole country and were open
for people from another districts as well. What is shocking is
when examining the chiefdoms and villages they are coming from
because a large part of the workers came from the same places:

This is clearly related with the language challenges both patients
and staff were facing while trying to communicate ones with each
other:

FIGURE 20. CHIEFDOMS IN MOYAMBA STAFF
IS COMING FROM

FIGURE 22. MAJORITY ETHNIC GROUPS OF THE WORKERS
50

70

45

60

40
35

50

30
40

25

30

20
15

20

10
5

10

FULLAH

KISSI

KONO

KONGBORA

LIMBA

KARGBORO

LOKO

KAIYAMBA

MANDINGO

FAKUNYA

SHERBRO

BAGRUWA

TEMNE

0

MENDE

0

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 31

If the ETC is receiving patients from the whole district, while
the vast majority of the staff comes from the same area and
speaks the same language, it is quite obvious that sooner or
later communication problems will arise. This communication
gap is exacerbated in the case of women, many of them illiterate.
According to UNICEF, just 52% of girls aged 15-24 are literate,
compared to 70% of boys339 and as reported by Sierra Leone
2013 Demographic and Health Survey340 as well.
Key informants explained that only the Paramount Chief was
involved in candidate selection and no other main stakeholders as
the Social Mobilization Pillar were engaged to provide applicants
from all the chiefdoms of the district. Although, it must be said
that the vacancies were advertised on local radios:

FIGURE 23. H 
OW DID YOU FIND OUT ABOUT THE JOB
IN THE ETC?
45 

ome people were not confident answering/writing in English,
S
so they were answering in creole, and the answers were later
translated into English 
ost of the staff member come from the same areas and they
M
were not very comfortable answering questions about the fact
Recommendations: 
ake sure that the means used to announce jobs vacancies
M
reach women from all the communities in the district by
involving women’s organizations and Social Mobilization Pillar in
the dissemination of the messages 
ry to ensure equal participation of women and men in all
T
teams 
Guarantee diversity (of origin, religious and ethnic) among ETC
personnel

POSITIONS AND ROLES
OF WOMEN AND MEN

40
35
30

Most of the employees are in a relationship and have children:

25
20

FIGURE 24. MARITAL STATUS MOYAMBA ETC STAFF

15

18

10

16

5

14

0

FRIENDS &
RELATIVES

RADIO

OTHERS

N/A

This seems a fair method of reaching most of the population,
women and men, but as it was pointed out before, not all women
have access to radio.
Challenges encountered: 
hort time frame to test the questionnaires, do the interviews
S
and input the data 
Support team only available for a few days 
ecause of this there were up to 6 people in the same room
B
filling (individually) the questionnaires, which it is not ideal 
ome supervisors didn’t want the participants to fill the
S
questionnaires during working hours, so the staff had to extend
their workday to participate

19. Shamed and Blamed: Pregnant Girls’ Rights at Risk in Sierra Leone, Amnesty
International, 2015
20. Sierra Leone 2013 Demographic and Health Survey-Key Findings, http://
dhsprogram.com/publications/publication-SR215-Summary-Reports-Key-Findings.
cfm

32 I Moyamba District, Sierra Leone. March 2016

Single
Married
Widow/er
Divorced
Fiancée

12
10
8
6
4
2
0

MEN

WOMEN

18-25 years

MEN

WOMEN

25-35 years

MEN

WOMEN

35-45 years

MEN

WOMEN

45-60 years

FIGURE 25. DO YOU HAVE CHILDREN?

FIGURE 27. HAVE YOU CHANGED THE LOCATION
TO WORK IN THE ETC? (MEN)

50

22,5

45

22

40
21,5

35
30

21

25
20,5

20
15

20

10
19,5

5
0

NO

YES

Out of 27 women responding to the question Do you have
children? 37% of them have them alone (they are single or
widows) compared to only 19% of men. This increases the burden
that women already face and should be taken into account
while planning and implementing the project to ensure measures
designed to reconcile family and working life for them.
When asked if they had to change location to work in the ETC
the differences between the responses of men and women are
overwhelming:

FIGURE 26. HAVE YOU CHANGED THE LOCATION
TO WORK IN THE ETC (WOMEN)

19

NO

YES

Most of the men who moved did it without family. Out of 22233, 19
left it behind while only 2 of the women did it. In all cases people
left to care for the families of the workers were mostly women:
in-law, mothers, sisters, wives... This clearly shows that men have
more power of decision over their lives: whether or not to work,
where… and also it demonstrates that women in a relationship
have less agency234 than those single.
This can be directly related to the answer to the question, Are you
the head of household?, which, in other words can be the same
as Are you the one taking decisions at home?. We also see here
that mostly men exercise this role, being the difference bigger in
the age range between 25-35, and becoming equal in the age
range between 45-65 years old:

25

FIGURE 28. ARE YOU THE HEAD OF THE HOUSEHOLD?
20

30

15

25

No

Yes

20

10

15
5
10
0

NO

YES

5
0

WOMEN

MEN

21. Out of 69 respondents 22 men and 4 women changed their location to work in
the ETC.
22. Ability for a person, or agent, to act for herself or himself. A person who is not
allowed to act for herself/himself is lacking an agency, or is said to have been denied
agency.

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 33

FIGURE 29. HOUSEHOLD HEADS DISAGGREGATED
BY SEX AND AGE 

ome supervisors didn’t want the participants to fill the
S
questionnaires during working hours, so the staff had to extend
their workday to participate

16

Yes

No

14
12 

ome people were not confident answering/writing in English,
S
so they were answering in creole and the answers later
translated into English
Recommendations:

10
8 

o ensure measures designed to reconcile family and working
T
life for single women with children

6 

Gender awareness for women to empower them in decision
making

4

LEADERSHIP

2
0

MEN

WOMEN

18-25 years

MEN

WOMEN

25-35 years

MEN

WOMEN

MEN

35-45 years

WOMEN

45-65 years

FIGURE 30. HOUSEHOLD HEADS IN THE HOMES
OF THE RESPONDENTS
14

Most of the supervisors of the local staff were expatriates33 of
both sexes and only 42% of the local employees held leadership
positions, being the majority of them exercised by men (32%) and
only by few women (9,8%). While for men leadership positions
were in diverse areas: medial, IPC, PSS, log and administration,
for women most of them were only medical (4 out of 7), PSS and
kitchen, areas commonly associated with women’s traditional
roles.
The largest team, which was the IPC, had not even a single
woman in a leadership position and since the beginning a high
percentage of its members were men34.

12
10
8

FIGURE 31. LEADERSHIP POSITIONS HELD BY WOMEN
AND MEN IN THE ETC

6

25
4
20

2
0

15
FATHER

MOTHER

BROTHER

HUSBAND

WIFE

UNCLE

PARENTS

10

It seems obvious that, according to the graphic, men have a
higher capacity than women to decide whether they move or not
in search of work. When women decide to do it, other women
take care of their families. The cases of men as caregivers are
very rare; and when they do, they are not in working age.
Challenges encountered:

5

0

WOMEN

MEN 

hort time frame to test the questionnaires, do the interviews
S
and to input the data
Support team only available for few days 
ecause of this there were up to 6 people in the same room
B
filling (individually) the questionnaires, which it is not ideal

34 I Moyamba District, Sierra Leone. March 2016

23. Out of 69 respondents 43 said their supervisors were expatriates, 25 said they
were both local and expatriates and only 1 said the supervisor was local.
24. At the time of the assessment out of 160 people 69 were IPC, only 12 of them
were women (17%) compared to 57 men (82%).

The project could have strengthened women’s leadership and has
not done it; furthermore, it has reinforced traditional roles and the
subordination of women to men.
About the expatriates, when looking at the positions held by sex,
we see that here too the figures are more equitable than those for
the local staff. Both men and women have occupied leadership
positions and all the teams have had members of both sexes.

“(…) women who earn an income from work often achieve greater
economic autonomy and decision making power within families,
workplaces and communities. They also gain confidence, security
and flexibility.”
This can be seen as a positive impact of the project that has
opened opportunities for women, strengthening their ability to
decide on their future and their agency.

The answers to the question about what they would like to do
once they finished their work in the ETC vary from men to women:

Regarding to men, 43%36 of the respondents want to continue
with their studies and to find a job after finishing working in the
ETC.

FIGURE 32. WHAT WOULD YOU LIKE TO DO AFTER
THE CLOSING OF THE ETC?

Challenges encountered: 
hort time frame to test the questionnaires, do the interviews
S
and to introduce the data

20 

Support team only available for few days

18

Men

Women

16 

ecause of this there were up to 6 people in the same room
B
filling (individually) the questionnaires, which it is not ideal

14 

ome supervisors didn’t want the participants to fill the
S
questionnaires during working hours, so the staff had to extend
their workday to participate

12
10 

ome people were not confident answering/writing in English,
S
so they were answering in creole, and the responses later
translated into English

8
6
4

Recommendations:

2 

ry to ensure equal participation of women and men in all
T
teams
OTHERS

ADVOCATE
FOR WOMEN

BACK TO MY
PREVIOUS JOB

START A
BUSSINESS

DO MORE
TRAININGS

FIND A
NEW JOB

CONTINUE
STUDYNG

0

Most of the women want in first place to complete their education
(37%)33, followed by the wish to find another job or to start a
business. This is a very good symptom since only 53.8% of the
Sierra Leonean women are literate. compared to 71,6% of men;
the expected years of schooling for females are 7.2 while for
males are 10.0, and the average number of years of education for
women are 2.2 compared to 4.0 for men34.
According to the Human Development Report 2015, only 10% of
women in Sierra Leona have at least some secondary education,
compared to 21.7% of men.
In Chapter 1 of the same report it shows that:
35

25. 10 out of 27 women 

reak traditional subordinated role of women by ensuring
B
they have access to leader ship roles in the ETC (i.e. positivediscrimination measures) 
Counsel women who wish to continue their studies or career
with specific trainings and/or capacity building

USE OF TIME
There are some activities that are marked by the employees as
done with a high frequency such as cleaning, cooking, doing the
laundry, ironing, taking care of children and praying. The time
taken to perform them varies between men and women, but
women spend many more hours in most of them.
We have to think about the already existing burden that women
have when we talk about house cores and other work they do
without being paid for. If we add the ETC duties, most of them
see their workload multiplied. Only one of the respondents said
she had hired a caretaker.
A greater number of staff said their daily activities had changed
since they work in the ETC:

26. Human Development Report 2015. Work for Human Development.
http://report.hdr.undp.org
27. Human Development Report 2015. Work for Human Development.
http://hdr.undp.org/sites/default/files/chapter1.pdf

28. 18 out of 42 men

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 35

FIGURE 33. ARE YOUR DAILY ACTIVITIES THE SAMEAS
BEFORE YOU STARTED WORKING AT THE ETC?
35

Women

FIGURE 34. PERCENTAGE OF WOMEN AND MEN
TAKING CARE OF HOUSE CORES BEFORE
WORKING IN THE ETC
80

Men

Women

30

Men

70

25

60

20

50
40

15

30
10
20
5
0

10

NO

YES

For most of them, the sleeping time has increased, as well as
the free time to chat with friends. A large number of women said
that their work schedule had changed, which means that apart of
the benefits of sleeping more, many of them have increased the
number of activities and, as they have a daily routine in the ETC,
they have to perform other cores (cleaning the house, washing
clothes, ironing…) in their free time.
This can be related to the informal jobs they had before, less
stable and without defined time schedule. Working at the ETC
they have a fixed schedule, better salary and secure working
conditions that allow them to organize better their time.
Men, instead, have increased their free time or time for their
personal issues, like Internet browsing, chatting with friends,
watch TV/movies, etc.
This shows that the roles women and men were performing before
working in the ETC were perpetuated while working in it.
Out of 69 respondents (27 female, 42 male) 20 women (74%)
answered they were taking care of housework before working in
the ETC compared with only 23% of men (10). When asked if they
were still in charge of it after starting in the ETC same number of
men answered yes (10) while the number of women decreased
(12), but the difference with the number of men remains
enormous:

0

FIGURE 35. PERCENTAGE OF WOMEN AND MEN TAKING
CARE OF HOUSE CORES AFTER WORKING IN
THE ETC
40%

Women

Men

35%
30%
25%
20%
15%
10%
5%
0%

Challenges encountered: 
Short time frame to test the questionnaires, do the interviews
and to introduce the data 
Support team only available for few days 
ecause of this there were up to 6 people in the same room
B
filling (individually) the questionnaires, which it is not ideal 
ome supervisors didn’t want the participants to fill the
S
questionnaires during working hours, so they had to extend
their workday to participate 
ome people were not confident answering/writing in English,
S
so they were answering in creole and the answers later
translated into English

36 I Moyamba District, Sierra Leone. March 2016

Recommendations:

This independence when making decisions on incomes is mainly
in the age range of 25 to 35 years: 

o ensure measures designed to reconcile family and
T
working life 
ender workshops for both men and women focused in
G
highlighting the burden on women’s unpaid housework and to
develop strategies for improvement

FIGURE 37. D 
ECISION MAKING, REGARDING THE
INCOMES, AT HOME LEVEL DISAGGREGATED
BY SEX AND AGE (WOMEN)
9

USE AND CONTROL
OF RESOURCES

18-25
25-35
35-45
45-65

8
7

When we got to the section of control and use of resources we
see that, surprisingly, a large number of women said that they
control the income they receive and they decide how to use it:

6
5
4
3

FIGURE 36. WHO DECIDES WHAT TO DO AND HOW
TO USE THE INCOMES AT HOME?
20

Women

18

2

Men

1
0

16

ME

BOTH

OTHER

N/A

14

FIGURE 38. DECISION MAKING, REGARDING THE
INCOMES, AT HOME LEVEL DISAGGREGATED
BY SEX AND AGE (MEN)

12
10

12

8
6

18-25
25-35
35-45
45-65

10

4
2
0

8

ME

BOTH

OTHER

N/A

6

4

2

0

ME

BOTH

OTHER

N/A

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 37

This differs from the information gathered in focus groups and
informal discussions, since there have been some conflicts
between some of the female workers who wanted to control their
incomes and their partners.
Priorities on income expenditures are as follows:

FIGURE 41. IS YOUR PARTNER WORKING (MEN)
40
35
30

FIGURE 39. USE OF INCOMES

25

40

Women

20

Men

35

15

30

10

25

5

20

0

15
10

NO

FURNITURE

HOUSE RENT

FARMING

ENTERTAINMENT

PAYING THEIR OWN STUDIES

HOUSE CONSTRUCTION

CLOTHING

FAMILY SUPPORT

INVESTMENTS

MEDICATION

FEEDING

SCHOOL FEES

For those women whose couples are working, most of the
professions they carry out are qualified: mechanical engineers,
teachers, social workers or finance managers. When asked why
their partners are not working, the reasons were mostly death and
lack of job.
Men with working partners said they are mostly employed in
low-skilled jobs like farming, small business, community health
worker or social mobilization, and most of those unemployed are
still studying (40%)34, caring for children (6%)35 or they don’t have
formal education (8,5%)36.

The answers to the question Is your partner working? are quite
revealing:

FIGURE 40. IS YOUR PARTNER WORKING (WOMEN)
12

For both respondents, men and women, most of the priorities are
related with family wellbeing and family support, although in focus
groups many respondents expressed their concern about the
economic expectations their families and relatives have now that
they have a good income every month. This can be better seen in
the following graphics of improvements and challenges faced by
the staff due to their work in the ETC:

10

8

6

4
29. Out of 69 respondents, 27 females, 42 males

2

30. 14 out of 35

0

N/A

A good number of women answered affirmatively (37%) while a
high percentage of men33, 83%, said their partners don’t work.

5
0

YES

31. 2 out of 35

YES

NO

38 I Moyamba District, Sierra Leone. March 2016

N/A

32. 3 out of 35

FIGURE 42. IMPROVEMENTS FOR MEN AND WOMEN
DUE TO THEIR JOB AT THE ETC

For the majority of the personnel, the main improvement has
been the capacity building, followed by economic improvement,
professional experience and new friends made. For women,
capacity building was also highly relevant, followed by the
economic independence, which probably means they didn’t have
it before. As stated above, this has been a source of conflict
between some of the female workers and their partners.

30

Women

Men

25

20

“ Women independence is now better, some of them can
choose what to do”

15 

“ Young women engaged in job so they have left different boys.
They are more mature and they have motivation”
Regarding the capacity building, several trainings were organized
in the ETC. Out of 69 respondents 27 women and 42 men
received training. The contents were:

10

5

STATUS IMPROVEMENT

MAKING FRIENDS

LEADERSHIP EXPERIENCE

DIGNITY

PROFESSIONAL EXPERIENCE

ECONOMIC IMPROVEMENT

CAREER IMPROVEMENTS

NEW SKILLS 

EVD immunology and vaccines
ECONOMIC INDEPENDENCIA

0 

Traumatology in emergency contexts 
EVD late complications 
Patients management 
Maternal and child health and EVD 
Triage training 
riage training for the Moyamba District Hospital
As part of this evaluation two gender workshops took place, one
for the psychosocial team (Annex 5) and other for the medical
team (Annex 6).
Challenges encountered:

FIGURE 43. CHALLENGES FOR MEN AND WOMEN DUE TO
THEIR JOB AT THE ETC 

hort time frame to test the questionnaires, do the interviews
S
and to introduce the data

14 

Support team only available for few days

Women

Men 

ecause of this there were up to 6 people in the same room
B
filling (individually) the questionnaires, which it is not ideal

12 

ome supervisors didn’t want the participants to fill the
S
questionnaires in working hours, so the staff had to extend their
workday to participate

10
8 

ome people were not confident answering/writing in English,
S
so they were answering in creole, and the responses later
translated into English

6 

Some of the questions were too sensitive and others were not
properly formulated, so it is likely that the information in this
aspect is biased/incomplete

4
2

ABUSES BY LOCALS

ABUSES BY EXPATS

TRANSPORTATION TO ETC

PRICES INCREASED

LESS TIME FOR HOUSE CORES

LESS TIME WITH FAMILY

CHLORINE

PPE

DISCRIMINATION

STIGMA

FEAR TO CONTRAT THE VIRUS

FREQUENT CHANGE OF

INCREASED EXPENDITURE

Recommendations:
FINANCIAL EXPECTATIONS

0 

Encourage recruitment of women in vulnerable situations 
Continue with trainings and capacity building of the staff 
Counsel women who wish to continue their studies or career
with specific trainings and/or capacity building

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 39

IMPACT OF WORKING
IN AN ETC

FIGURE 45. HAVE YOU FELT ANY KIND OF DISCRIMINATION
(RACE, SEX, POSITION, RELIGION, STATUS...)
IN THE ETC?
25

Coming to the issue of stigma, out of 67 respondents (25 female,
42 male) 68% of the women and 74% of men declared having
suffered it:

Women
20

FIGURE 44. HAVE YOU BEING SUBJECTED TO STIGMA
OR REJECTION BECAUSE OF BEING WORKING
IN AN ETC?

15

35

10

Women

Men

Men

30

5

25
0

20

YES

NO

N/A

15

FIGURE 46. DID YOU SUFFER ANY SEXUAL HARASSMENT/
VIOLENCE/ABUSE IN THE ETC?

10

40

5

35
0

YES

NO

N/A

Both men and women interviewed said they were stigmatized by
being refused by friends and relatives, having their money rejected
at the market, not allowing their children to play with others’
children, etc.
In the focus group discussions, women said boyfriends and
husbands abandoned them saying they will get infected and die
but, as soon as they saw that was not happening and women
were getting money, men came back.
There were also cases of mothers telling their daughters they
could go and work at the ETC, risking their lives, but not allowing
the sons to do the same, assuming it was better to lose a female
than a male.
When it comes to discrimination in the ETC, out of 67
respondents (25 female, 42 male) 32% of women and 45% of
men responded affirmatively. Most of the issues that came up
were related to differences between the local and expatriate staff:

40 I Moyamba District, Sierra Leone. March 2016

Women

Men

30
25
20
15
10
5
0

YES

NO

N/A

The only woman who answered affirmatively said she was not
telling it to anybody, but the two men said they told it to someone
they trusted.
It has to be pointed out that the question was not formulated
correctly as it was intended to refer to sexual abuse, sexual
harassment and sexual violence; instead it turned out to be
confusing, as shown by the answers given by respondents to the
question about possible measures that the organization should
take to avoid these situations: 
To counsel their workers on management skills 
have a special mediator team for that. To regularly call
To
meetings to know the difference and find a solution for it 
put the right man in the right place and talk to position
To
holders to know how to talk to their local staff
Therefore, after analyzing the responses to the questionnaires
and the focus group discussions, it was clear that they referred to
situations of abuse of power related to supervisors and that had
nothing to do with sexual violence.
In the focus group discussions, men stated they have realized
women feel uncomfortable when standing up in front of them
in the queue to pick up food because they think men will touch
them. This is a good example of how widespread is the abuse
and harassment that women are subjected to, although it has not
been reflected in the responses given in the survey. Again, as it is
an extremely sensitive subject, a specific study may be needed
for this if the subject is to be analyzed in depth.

Challenges encountered: 
hort time frame to test the questionnaires, do the interviews
S
and to introduce the data 
Support team only available for few days 
ecause of this there were up to 6 people in the same room
B
filling (individually) the questionnaires, which it is not ideal 
ome supervisors didn’t want the participants to fill the
S
questionnaires in working hours, so the staff had to extend their
workday to participate 
ome people were not confident answering/writing in English,
S
so they were answering in creole, and the answers later
translated into English 
Some of the questions were too sensitive and others were not
properly formulated, so it is likely that the information in this
aspect is biased/incomplete
Recommendations: 
nsure there is a protocol to support workers who are victims
E
of stigma or rejection 
o put in place a specific protocol for sexual harassment,
T
sexual violence or sexual abuse inside the ETC 
Create a trusted figure to do the work of mediation in the teams

Also, in the focus groups came out the issue of violence
experienced by female workers by the hands of their partners.
Even if the psychosocial team was aware of it, and has attended
specific cases, there was no specific protocol on how to deal with
these situations.

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 41

CONCLUSIONS
The Ebola epidemic that has devastated Guinea, Liberia and
Sierra Leone has left in the last one a total of 14,123 cases and
3,955 deaths. According to WHO the number of women affected
exceeds 5.00033:
TABLE 6. CONFIRMED, PROBABLE AND SUSPECTED
EBOLA CASES IN SIERRA LEONE34
COUNTRY

CASE
DEFINITION

CUMULATIVE
CASES

CASES IN
CUMULATIVE
PAST 21 DAYS DEATH

SIERRA
LEONE

CONFIRMED

8.704

0

3.589

PROBABLE

287

*

208

SUSPECTED

5.131

*

158

TOTAL

14.122

0

3.955

CONFIRMED

1

1

1

During the last few weeks, two new cases of women infected with
the virus in Sierra Leone have been confirmed, one deceased and
the other infected after caring for the first one.
As it can be extracted from the data and documentation referred
to throughout the document, the response to the epidemic in
Sierra Leone has been blind to gender.
The Ebola outbreak in West Africa has been considered a Public
Health Emergency of International Concern, representing a
health risk not only to neighbour countries, but worldwide. All
stakeholder agree in highlight that the International response
came late; in August 2014 already there were 1427 deceased
people and MSF was nearly the only Organization dealing with
it.35 The late response, the high mortality and the risk of infectious
have been key factors in prioritizing the health approach of the
outbreak. However, other issues of great importance like the
questioning of traditional roles played by men and women have
been put aside. These roles affect their exposure to the virus and
increase the risk of infection and the severity of the illness.

33. Wsee Table 3. http://apps.who.int/ebola/current-situation/ebola-situation-report23-september-2015 Population figures are based on estimates from the United
Nations Department of Economic and Social Affairs. These numbers are subject to
change due to ongoing reclassification, retrospective investigation and availability
of laboratory results. *Excludes cases for which data on sex are not available.
‡Excludes cases for which data on age are not available. Data are until 9 May 2015.
34. http://apps.who.int/ebola/current-situation/ebola-situation-report-20january-2016 Sierra Leone was declared free of Ebola virus transmission in the
human population on 7 November 2015, and entered a 90-day period of heightened
surveillance. On 14 January, 68 days into the 90-day surveillance period, new
confirmed cases of EVD were reported in Sierra Leone after a post-mortem swab
collected from a deceased 22-year-old woman tested positive for Ebola virus. The
woman died on 12 January at her family home in the town of Magburaka, Tonkolili
district, and received an unsafe burial.
35. http://www.msf.org/article/ebola-failures-international-outbreak-response

42 I Moyamba District, Sierra Leone. March 2016

WOMEN’S ACCESS TO HEALTH,
INFORMATION AND KEY ROLES IN
THE EBOLA RESPONSE
One of the main findings of the evaluation is that women basic
access to health is minimal, depending on the authorization of
the partner/other male member of the family. This factor, coupled
with the fact that women don’t have the economic resources has
meant that women arrived too late to the Treatment Center with
the disease in a more advanced stage compared with men. Not
taking into account a gender perspective has left unattended and
unprotected more than half of the population. If we also consider
the role of caretakers of women, they and the entire family units
have been put at risk.
Further, women didn’t have access to basic information in an
Ebola outbreak, i.e. knowledge about transmission modes,
preventive measures, where to go... key in facilitating informed
decision making. By not considering this fact the intervention has
failed in promoting women’s decision making related to the access
to health services, and in improving their right to health.
This failure could have been mitigated by consulting and working
together with Women’s Organizations operating in the district.
Fortunately, they were soon incorporated in all clusters dealing
with the Ebola Response and their knowledge taken into account
in further sensitization campaigns.
Similarly, and with dire consequences for the health of women,
can be said about the non-inclusion of women in the Surveillance
Teams. This has meant that many women that could have
matched the case definition never accessed any Treatment
Centre/ health care.

ETCs
Treatment centres, meanwhile, lacked any gender sensitivity,
except those exclusively dedicated to maternity in which there
were only women. Women were not included in the design and
construction of the ETCs, and once opened, despite the urgency
of the epidemic, local knowledge could have been taken into
account.
Such knowledge, if applied, would have shown how to adapt the
existing structures, so that they were as respectful as possible
towards sensitive issues such as nudity or vulnerability to the
disease of people of the opposite sex, that when ignored have
generated psychological problems in many of the women who
have survived Ebola.36

36. Report of the Multi Sectoral Impact Assessment of Gender Dimensions of the
Ebola Virus Disease (EVD) in Sierra Leone, Ministry of Social Welfare, Gender and
Children’s Affairs, UN Women, Oxfam, Statistics of Sierra Leone, December 2014

Regarding the construction of the ETC, there was not much room
to propose changes in the infrastructure, although the responsible
for the realization were asked to include, for instance, separate
toilets, which was not possible. However, it must be highlighted
the importance of sanitary facilities separated by sex, to respect
privacy and to prevent abuse or violence against women.
Médicos del Mundo, on the other hand, would have had a great
opportunity to alleviate the negative effects the disease has
on women. However, patterns that contribute to deepen the
structural differences between genders, with negative effects for
women, have been repeated.

FEMALE STAFF
Concerning the demand both from the patients and workers to
treat same-sex people, it has been difficult because most of the
health workers were women; nursing is a profession related with
care, and therefore is highly feminized.
However, apart from the female workers of the medical team, the
vast majority of the local staff of the centre were men. This may
be due to the difficulty in finding qualified female staff, but the
numerical differences were excessive, especially in teams like IPC,
This has led to perpetuate traditional roles: women dedicated
to caring (nursing, psychosocial, laundry, kitchen...) and men to
those which require more technical skills or that are socially best
rated (IPC, logistics, administration, drivers...).

CONCILIATION MEASURES
The evaluation results show that the burden of women has
doubled since having a fixed monthly income has not stop them
to take care of household chores, but continue to carry them
out at their leisure time. The implementation of a conciliation
measures policy would have facilitated the situation of single
women in combining work and family and most likely the number
of female workers had been higher.

GENDER AWARENESS
Regarding gender and sexual based violence, no protocols were
put in place, neither for workers nor for patients. Although no
cases have been reported inside the centre, we have knowledge
that the psychosocial team knew and took care of these
situations that occurred within the community, but did so in an
informal way leaving structural violence in the private sphere.
This reality could have been mitigated if all staff, in particular the
psychosocial team have had some capacity building regarding
gender and sexual based violence.

Although PSS team was aware of the situation of women
and girls and the vulnerability of these when returning to their
communities once discharged, the organization did not put in
place an specific policy that would have facilitated the support
and referral of vulnerable cases and/or to coordinate with other
organizations to ensure the welfare of women and girls in their
communities.

CAPACITY BUILDING
With regard to the positive impact of the intervention, it can be
said that the training of local staff has been a priority since the
beginning of the project, and the satisfaction of the workers
concerning this is reflected in their answers on the evaluation.
The trainings have not only been associated with topics related
to the work done in the ETC, but they have also been expanded
according to the demands made by the staff at the time to
organize them and carry them out.

POSITIVE IMPACTS ON WOMEN
It also looks like the quality of life of women has improved with
respect to sleep, as it has increased since they work in the ETC.
Also, precariousness has been reduced because most of the
women had, previously, informal jobs with low-wage and without
schedules. With the work in the treatment centre they have
gained organization, diversified time for each task and secured a
steady income.
This has also been reflected in a greater autonomy of women,
as a result of a higher economic independence, which has led to
greater agency and a greater capacity decision, such as deciding
to continue with their studies or continue working, if she did not
do it before.
In addition, has to be highlighted the significant effort that MdM
has done to adapt itself to the changing situation, being an
example of this the implementation of outreach activities or the
greater involvement and support to DERC and its activities as the
project progressed.
Therefore, despite everything, the project has had an impact that
can be considered as very positive for women, at least for female
workers. However, it would be desirable in future emergencies
of similar characteristics to take gender approach into account
in order to reduce the gender gap between women and men
regarding at least the right to health.

All teams were missing gender training, both local and expatriate,
which has become a deficiency and insensitivity to these issues
that has undermined the autonomy and the right to health of
women before, during and after the epidemic.

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 43

RECOMMENDATIONS
Infrastructure 
ake into account anthropological point of view when designing
T
Ebola Treatment Centres and any infectious disease intervention
(separate ablutions and wards in all the zones: white, green and
red) 

o have gender sensitive staff: for privacy and protection
T
of women and girls and also to understand the importance
of gender issues in general and in emergency contexts in
particular 
o be flexible to change the project strategy to ensure that it
T
suits women specific needs 

omen should participate in all phases of the project: women
W
needs will not be covered if they are not actively involved

TRIAGE & TREATMENT

I t is important to involve local staff (female and male) in the
design and management of the ETCs as much as possible; they
know social and cultural dynamics and we can find alternatives
together to accommodate to local customs

To have gender sensitive staff: for privacy and protection of
women and girls and also to understand the importance of gender
issues in general and in emergency contexts in particular 

o advocate for segregated wards and the integration of
T
gender specific interventions into Ebola Response activities and
stakeholders involved 
here should be separate toilet facilities to guarantee privacy
T
and security of women and girls

Before, during and after
ETC arrival
USE AND CONTROL OF RESOURCES 
o promote the right to information of women to alleviate the
T
impact of Ebola 
Guarantee the participation of women in awareness raising 
o link up with local NGO’s through the Social Mobilization Pillar
T
to promote women involvement

44 I Moyamba District, Sierra Leone. March 2016

Ensure there is no loss of information by creating appropriate
protocols for transferring it to other expatriates
To be flexible to change the project strategy to ensure that it
suits women needs
Ask local staff about recommendations to improve the
treatment of patients
Valuing local knowledge

DISCHARGE 
o have gender sensitive staff: for privacy and protection
T
of women and girls and also to understand the importance
of gender issues in general and in emergency contexts in
particular 
o monitor the conditions of women and girls once they return
T
to their communities and to coordinate with other organizations
to ensure that the rights of women and girls are not violated 
o recognize and compensate the unpaid effort of women
T
taking care of sick members of their families during the EVD
outbreak

Staff

LEADERSHIP

EDUCATION 
rioritize educated women rather than men because there are
P
fewer of them 
ry to ensure equal participation of women and men in all
T
teams 
Promote trainings and capacity building in all teams 

Try to ensure equal participation of women and men in all
teams 
Ensure that women have access to leadership positions 
Counsel women who wish to continue their studies or career
with specific trainings and/or capacity building

USE OF TIME 
To ensure measures designed to reconcile family and working
life

ORIGIN 
ake sure that the means used to announce jobs vacancies
M
reach women of all the communities in the district by involving
women’s organizations and Social Mobilization Pillar in the
dissemination of the offers
Try to ensure equal participation of women and men in all
teams 
Guarantee diversity (of origin, religious and ethnic) between
ETC personnel

POSITION AND ROLES
OF WOMEN AND MEN 

Gender workshops for both men and women focused in
highlighting the burden of women’s unpaid housework and to
develop strategies for improvement

USE AND CONTROL OF RESOURCES 
Encourage recruitment of women in vulnerable situations 
Continue with trainings and capacity building of the staff 
Counsel women who wish to continue their studies or career
with specific trainings and/or capacity building

IMPACT OF WORKING IN AN ETC 

o ensure measures designed to reconcile family and working
T
life for single women with children 

Ensure there is a protocol to support workers who are victims
of stigma or rejection 

Gender awareness for women to empower them in decision
making 

To put in place a specific protocol for sexual harassment,
sexual violence and sexual abuse inside the ETC 
Create a trusted figure to do the work of mediation in the teams

Gender Evaluation of Doctors of the World and Médicos del Mundo Ebola response in Moyamba Ebola Treatment Center Project I 45

References 
Amnesty International, Shamed and Blamed: Pregnant Girls’
Rights at Risk in Sierra Leone, 2015 
Defence for Children International, A Mountain to Climb.
Gender Based Violence and Girl’s Right to Education in Sierra
Leone, May 2015, http://www.defenceforchildren.org/wpcontent/uploads/2015/06/GBV-and-Girls-Right-to-Educationin-Sierra-Leone_May2015_EN.pdf 
Demographic and Health Survey-Key Findings, Sierra Leone
2013, http://dhsprogram.com/publications/publication-SR215Summary-Reports-Key-Findings.cfm 
Ebola Treatment Centers Database, https://data.hdx.rwlabs.
org/dataset/ebola-treatment-centers/resource/e8a9fa59-50684d2d-855e-788c63d061e8 
Ministry of Social Welfare, Gender and Children’s Affairs, UN
Women, Oxfam, Statistics of Sierra Leone, diciembre 2014,
Report of the Muti Sectoral Impact Assessment of Gender
Dimensions of the Ebola Virus Disease (EVD) in Sierra Leone 
Richards, Paul, Amara, Joseph, Ferme, Mariane c., Kamara,
Prince, Mokuwa, Esther,Idara Sheriff, Amara, Suluku, Roland,
Voors, Marteen, Powers, Ann M., Social Pathways for Ebola
Virus Disease in Rural Sierra Leone, and Some Implications for
Containment 
Save the Children, UNICEF, Plan, World Vision, Children’s Ebola
Recovery Assessment: Sierra Leone, March 2015 
TAQI, Dr. Fatmatta, Rapid Gender Assessment Report of the
Ebola Response in Sierra Leone’s OXFAM Operational Areas,
12th January 2015 
UNDP, Human Development Report 2015. Work for Human
Development. http://report.hdr.undp.org 
WHO, Addressing sex and gender in epidemic-prone infectious
diseases, 2007 
WHO, Ebola Situation Report, 20 enero 2016 http://apps.
who.int/ebola/current-situation/ebola-situation-report-20january-2016 
WHO, Ebola Situation Report, 23 septiembre 2015, http://
apps.who.int/ebola/current-situation/ebola-situation-report-23september-2015

46 I Moyamba District, Sierra Leone. March 2016

Annexes
ANNEX 1. ToR Gender Evaluation Ebola Response Dotw/
Médicos del Mundo (MdM) in Moyamba ETC, Sierra
Leone
ANNEX 2. Consent Script
ANNEX 3. Evaluation Form
ANNEX 4. Surveillance Team Triage Form
ANNEX 5. Moyamba ETC Triage Form
ANNEX 6. Medical Team Gender Workshop
ANNEX 7. PSS Team Gender Workshop

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